Provider Demographics
NPI:1467980904
Name:BREWER, JOSEPH LEWIS (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEWIS
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 1:2676 S TUCANA CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1450
Mailing Address - Country:US
Mailing Address - Phone:928-242-2387
Mailing Address - Fax:
Practice Address - Street 1:2676 S TUCANA CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1450
Practice Address - Country:US
Practice Address - Phone:928-242-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2116OtherARIZONA OPTOMETRIC ASSOCIATION