Provider Demographics
NPI:1982741658
Name:BRUNNETT, SUSAN MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARY
Last Name:BRUNNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 RIDGELINE BLVD. #107
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129
Mailing Address - Country:US
Mailing Address - Phone:303-791-2727
Mailing Address - Fax:303-791-2529
Practice Address - Street 1:8925 RIDGELINE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2502
Practice Address - Country:US
Practice Address - Phone:303-791-2727
Practice Address - Fax:303-791-2529
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU09701Medicare UPIN
COD1423Medicare ID - Type Unspecified