Provider Demographics
NPI:1346235223
Name:BREWER, CLIFFORD WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:WAYNE
Last Name:BREWER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2800 HIGHWAY 90
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5115
Mailing Address - Country:US
Mailing Address - Phone:228-497-2020
Mailing Address - Fax:228-497-4820
Practice Address - Street 1:2800 HIGHWAY 90
Practice Address - Street 2:SUITE 1402
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5115
Practice Address - Country:US
Practice Address - Phone:228-497-2020
Practice Address - Fax:228-497-4820
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist