Individual
DR. REBECCA CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3501 S SHIELDS ST, FORT COLLINS, CO 80526-2583
(970) 490-2020
Mailing address
2908 DES MOINES DR, FORT COLLINS, CO 80525-6686
(815) 931-0011
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0003595
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003595
COLORADO DEPARTMENT OF REGULATORY AGENCIES
CO
Enumeration date
06/29/2020
Last updated
01/29/2021
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