Individual
DR. GARY T BRUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1801 E 5TH STREET, METROPOLIS, IL 62960
(618) 524-9323
(618) 524-9324
Mailing address
PO BOX 890, 1801 E 5TH STREET, METROPOLIS, IL 62960
(618) 524-9323
(618) 524-9324
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008374
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0413890001
DMERC
IL
05
—
046008374
—
IL
Enumeration date
12/12/2006
Last updated
12/02/2008
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