Provider Demographics
NPI:1083925572
Name:BREUER, JONI RUTH (OD)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:RUTH
Last Name:BREUER
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 1:714 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-5730
Mailing Address - Country:US
Mailing Address - Phone:712-262-3982
Mailing Address - Fax:712-262-7831
Practice Address - Street 1:714 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5730
Practice Address - Country:US
Practice Address - Phone:712-262-3982
Practice Address - Fax:712-262-7831
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist