Provider Demographics
NPI:1215100466
Name:PEXTON, BRETT ALDEN (OD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALDEN
Last Name:PEXTON
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 1:4144 LARAMIE ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1969
Mailing Address - Country:US
Mailing Address - Phone:307-635-1073
Mailing Address - Fax:307-635-1078
Practice Address - Street 1:4144 LARAMIE ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1969
Practice Address - Country:US
Practice Address - Phone:307-635-1073
Practice Address - Fax:307-635-1078
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2643152W00000X
WY322T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist