Provider Demographics
NPI:1154428787
Name:BRYAN, DEAN TYSON (OD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:TYSON
Last Name:BRYAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S WADSWORTH BLVD
Mailing Address - Street 2:101
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3273
Mailing Address - Country:US
Mailing Address - Phone:303-986-5983
Mailing Address - Fax:303-986-5473
Practice Address - Street 1:2525 S WADSWORTH BLVD
Practice Address - Street 2:101
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3273
Practice Address - Country:US
Practice Address - Phone:303-986-5983
Practice Address - Fax:303-986-5473
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT2143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2670540OtherAETNA
CO7520249OtherAETNA
CO45137014Medicaid
CO466918Medicare ID - Type UnspecifiedMEDICARE ID
CO45137014Medicaid
CO7520249OtherAETNA