Provider Demographics
NPI:1346273976
Name:BREWER, JEFFREY JOHN (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:BREWER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16949 LAKESIDE HILLS PLZ
Mailing Address - Street 2:STE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2433
Mailing Address - Country:US
Mailing Address - Phone:402-614-3200
Mailing Address - Fax:402-614-7070
Practice Address - Street 1:17520 WRIGHT ST STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4657
Practice Address - Country:US
Practice Address - Phone:402-614-3200
Practice Address - Fax:402-614-7070
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1254152W00000X
IA02349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist