Provider Demographics
NPI:1972945715
Name:BREWER, LANDON BLANE (OD)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:BLANE
Last Name:BREWER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:1400 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-6845
Practice Address - Country:US
Practice Address - Phone:270-247-2417
Practice Address - Fax:270-247-2090
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1917DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist