Individual
MICHAEL L. STREETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1650 COCHRANE CIR UNIT MEDDAC, FORT CARSON, CO 80913-4604
(719) 526-7450
Mailing address
1650 COCHRANE CIR UNIT MEDDAC, FORT CARSON, CO 80913-4604
(719) 526-7450
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT.0003728
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CO
Enumeration date
06/21/2021
Last updated
04/26/2024
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