Provider Demographics
NPI:1336277581
Name:BREWER, DAVID CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:BREWER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1207 S CORNWELL DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4633
Mailing Address - Country:US
Mailing Address - Phone:405-354-3384
Mailing Address - Fax:405-354-0703
Practice Address - Street 1:1207 S CORNWELL DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4633
Practice Address - Country:US
Practice Address - Phone:405-354-3384
Practice Address - Fax:405-354-0703
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK953152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK100380Medicare PIN
OKT40370Medicare UPIN
OK0175310001Medicare NSC