Provider Demographics
NPI:1609880509
Name:LAUER, BRENDON LLOYD (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:LLOYD
Last Name:LAUER
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 1:4710 CAMARGO CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4404
Mailing Address - Country:US
Mailing Address - Phone:979-690-8583
Mailing Address - Fax:
Practice Address - Street 1:1500 HARVEY RD
Practice Address - Street 2:SUITE #16
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-3713
Practice Address - Country:US
Practice Address - Phone:979-693-8476
Practice Address - Fax:979-764-9226
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5208T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0298283-01Medicaid
TX00221EMedicare ID - Type Unspecified
TX0298283-01Medicaid