Provider Demographics
NPI:1649883265
Name:BREWER, IANA (OD)
Entity type:Individual
Prefix:
First Name:IANA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:IANA
Other - Middle Name:
Other - Last Name:VOLODARSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:358 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6812
Mailing Address - Country:US
Mailing Address - Phone:215-676-8134
Mailing Address - Fax:
Practice Address - Street 1:950 INDUSTRIAL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4070
Practice Address - Country:US
Practice Address - Phone:215-357-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist