Organization
MARK E BREWER O D P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BREWER (PRESIDENT)
(309) 694-3951
Entity
Organization
Contact information
Practice address
401 RIVER RD, EAST PEORIA, IL 61611-2082
(309) 694-3951
(309) 694-3751
Mailing address
401 RIVER RD, EAST PEORIA, IL 61611-2082
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008770
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008770
—
IL
Enumeration date
01/16/2007
Last updated
01/28/2013
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