Provider Demographics
NPI:1043753700
Name:BREWER, ALLISON ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:ELIZABETH
Last Name:BREWER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 ROCK ST # UP
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-2539
Mailing Address - Country:US
Mailing Address - Phone:870-612-4478
Mailing Address - Fax:
Practice Address - Street 1:885 E US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-9367
Practice Address - Country:US
Practice Address - Phone:417-235-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016039534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist