Provider Demographics
NPI:1699872846
Name:BURRITT, DONALD R (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:BURRITT
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 1:7931 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8949
Mailing Address - Country:US
Mailing Address - Phone:970-225-2277
Mailing Address - Fax:
Practice Address - Street 1:7931 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8949
Practice Address - Country:US
Practice Address - Phone:970-225-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1288152W00000X
WY301T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU51918Medicare UPIN