Provider Demographics
NPI:1194702225
Name:BREWER, HENRY HOWARD III (OD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:HOWARD
Last Name:BREWER
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:15196 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4820
Practice Address - Country:US
Practice Address - Phone:229-228-4770
Practice Address - Fax:229-225-9060
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA867974975AMedicaid
GA867974975CMedicaid
GA867974975AMedicaid
GA41ZCFPHMedicare ID - Type Unspecified