Individual provider Active NPI

David Charles Brewer, O.D.

  • Optometrist
  • Yukon, OK
National Provider Identifier
1336277581
Registry record updated Jan 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
953 Issued in OK
Practice address
1207 S Cornwell Dr
Yukon, OK 73099-4633
Phone
(405) 354-3384
Fax
(405) 354-0703
NPI assigned
Mar 1, 2007
Last updated
Jan 5, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 953 OK Primary

Addresses

Primary practice location

1207 S Cornwell Dr
Yukon, OK 73099-4633

Mailing address

1207 S Cornwell Dr
Yukon, OK 73099-4633
Phone (405) 354-3384

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
953OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Eye Care PLLC Optometrist CurrentSince Aug 2, 2020 Accepting new patients

Locations

1207 Cornwell Dr
Yukon, OK 73099
Phone (405) 354-3384

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262649600000",
    "number": "1336277581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 S CORNWELL DR",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730994633",
            "telephone_number": "405-354-3384",
            "fax_number": "405-354-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 S CORNWELL DR",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730994633",
            "telephone_number": "405-354-3384",
            "fax_number": "405-354-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREWER",
        "first_name": "DAVID",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2010-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yukon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.