Provider Demographics
NPI:1528151503
Name:BREW, DAVID A (OD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:BREW
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 1:1136 CABRILLO AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4925
Mailing Address - Country:US
Mailing Address - Phone:650-344-3026
Mailing Address - Fax:650-344-3026
Practice Address - Street 1:1136 CABRILLO AVE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4925
Practice Address - Country:US
Practice Address - Phone:650-344-3026
Practice Address - Fax:650-344-3026
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10534Medicare UPIN
CASD0074230Medicare ID - Type Unspecified