Provider Demographics
NPI:1366546764
Name:BETTNER, CHRIS A (OD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:A
Last Name:BETTNER
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 1:9205 N UNION BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7830
Mailing Address - Country:US
Mailing Address - Phone:719-574-5064
Mailing Address - Fax:719-282-1004
Practice Address - Street 1:9205 N UNION BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7830
Practice Address - Country:US
Practice Address - Phone:719-282-0400
Practice Address - Fax:719-282-1004
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU84074Medicare UPIN