Provider Demographics
NPI:1699791798
Name:COLANDER, BRIAN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:COLANDER
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 1:711 N 1ST ST
Mailing Address - Street 2:APT D203
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1287
Mailing Address - Country:US
Mailing Address - Phone:773-510-9629
Mailing Address - Fax:563-328-5694
Practice Address - Street 1:4731 45TH STREET CT
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7102
Practice Address - Country:US
Practice Address - Phone:309-793-2020
Practice Address - Fax:309-793-2602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5594152W00000X
IL046.010635152W00000X
IA002565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist