Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 916 | CO |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 916 | CO |
N | 152WP0200X | Pediatric Optomitrist | 916 | CO |
NPI | 1225114002 |
---|---|
Provider Name | Dr. William P Breen |
First Address | Centennial, CO 80112-1433 |
Second Address | Centennial, CO 80112-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 03/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T60894 | (02) | CO |