Provider Demographics
NPI:1841211638
Name:BREWER, WILLIAM TIMOTHY (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TIMOTHY
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 1:6032 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3447
Mailing Address - Country:US
Mailing Address - Phone:731-686-3271
Mailing Address - Fax:731-686-1005
Practice Address - Street 1:6032 TELECOM DR
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3447
Practice Address - Country:US
Practice Address - Phone:731-686-3271
Practice Address - Fax:731-686-1005
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT1009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0075622OtherBLUE CROSS BLUE SHILED TN
TN35962761Medicaid
TN410014759Medicare PIN
TN35962761Medicare PIN
TN0146170001Medicare PIN
TN0146170001Medicare NSC
TN0075622OtherBLUE CROSS BLUE SHILED TN
TN35962761Medicaid