Provider Demographics
NPI:1619951316
Name:BROOKS, DREW J (OD)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:J
Last Name:BROOKS
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 1:2205 N CALHOUN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5062
Mailing Address - Country:US
Mailing Address - Phone:262-786-4144
Mailing Address - Fax:262-786-4729
Practice Address - Street 1:2205 N CALHOUN RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5062
Practice Address - Country:US
Practice Address - Phone:262-786-4144
Practice Address - Fax:262-786-4729
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38514200Medicaid
T61580Medicare UPIN
WI000347320Medicare PIN