Provider Demographics
NPI:1609091032
Name:VICKERS, BREE S (OD)
Entity Type:Individual
Prefix:DR
First Name:BREE
Middle Name:S
Last Name:VICKERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 KIMBROUGH RD
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-1319
Mailing Address - Country:US
Mailing Address - Phone:830-379-5686
Mailing Address - Fax:830-379-5691
Practice Address - Street 1:503 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5711
Practice Address - Country:US
Practice Address - Phone:830-379-5686
Practice Address - Fax:830-379-5691
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2527152W00000X
TX6287T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB127016Medicare Oscar/Certification