Provider Demographics
NPI:1447962741
Name:BREUER, SAMARA LILY
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:LILY
Last Name:BREUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:WI
Mailing Address - Zip Code:53582-9514
Mailing Address - Country:US
Mailing Address - Phone:608-574-5572
Mailing Address - Fax:
Practice Address - Street 1:1100 E VERONA AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8717
Practice Address - Country:US
Practice Address - Phone:414-329-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist