Provider Demographics
NPI:1902881782
Name:BREWER, MELISSA R (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:R
Last Name:BREWER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12621 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1701
Mailing Address - Country:US
Mailing Address - Phone:913-814-7707
Mailing Address - Fax:913-814-7997
Practice Address - Street 1:12621 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1701
Practice Address - Country:US
Practice Address - Phone:913-814-7707
Practice Address - Fax:913-814-7997
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35448021OtherKANSAS CITY BLUE CROSS
KS200331480AMedicaid
KS484E014Medicare ID - Type Unspecified
MO35448021OtherKANSAS CITY BLUE CROSS