Individual
LACEY B BRENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
250 MAX DR, SUITE 101, CASTLE PINES, CO 80108-9517
(303) 688-5066
(303) 688-6986
Mailing address
5850 ROY HTS, COLORADO SPRINGS, CO 80918-1593
(785) 821-0499
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0002932
CO
390200000X
Student in an Organized Health Care Education/Training Program
OEG002404
PA
Other
Enumeration date
02/04/2011
Last updated
05/28/2015
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