Provider Demographics
NPI:1811329824
Name:BREWER, KYLE (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20929 VENTURA BLVD STE 23
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3352
Mailing Address - Country:US
Mailing Address - Phone:818-883-4303
Mailing Address - Fax:818-883-5331
Practice Address - Street 1:20929 VENTURA BLVD STE 23
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3352
Practice Address - Country:US
Practice Address - Phone:818-883-4303
Practice Address - Fax:818-883-5331
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60562268152W00000X
MA5018152W00000X
PAOEG002754152W00000X
CAOD33555TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist