Provider Demographics
NPI:1316166697
Name:BREWER, ICEM E (OD)
Entity type:Individual
Prefix:DR
First Name:ICEM
Middle Name:E
Last Name:BREWER
Suffix:
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 1:2391 N HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6353
Mailing Address - Country:US
Mailing Address - Phone:479-225-1857
Mailing Address - Fax:
Practice Address - Street 1:4201 N SHILOH DR STE 1235
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5303
Practice Address - Country:US
Practice Address - Phone:479-444-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2559152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management