Provider Demographics
NPI:1053720755
Name:FLETCHER, BREANNA EMILY (OD)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:EMILY
Last Name:FLETCHER
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 1:4441 YATES ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2426
Mailing Address - Country:US
Mailing Address - Phone:720-377-7274
Mailing Address - Fax:
Practice Address - Street 1:4441 YATES ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2426
Practice Address - Country:US
Practice Address - Phone:720-377-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist