Provider Demographics
NPI:1386731727
Name:GRETCHEN J BREWER, OD & ASSOCIATES, INC
Entity type:Organization
Organization Name:GRETCHEN J BREWER, OD & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-332-7228
Mailing Address - Street 1:2329 COTTMAN AVE
Mailing Address - Street 2:ROOSEVELT MALL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149
Mailing Address - Country:US
Mailing Address - Phone:215-332-7228
Mailing Address - Fax:215-332-9337
Practice Address - Street 1:2329 COTTMAN AVE
Practice Address - Street 2:ROOSEVELT MALL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149
Practice Address - Country:US
Practice Address - Phone:215-332-7228
Practice Address - Fax:215-332-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01975355Medicaid
PA1354192OtherPERSONAL CHOICE BLUE CHOI
PA2051170000OtherKEYSTONE HEALTHPLAN EAST
PW2988538OtherAETNA
PAGR1354192OtherPA BLUE SHIELD
PA01975355Medicaid