Healthcare Provider Details

I. General information

NPI: 1487587036
Provider Name (Legal Business Name): ANDREW RYAN BROOKS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 EASTGATE BLVD # C578
CINCINNATI OH
45245-1218
US

IV. Provider business mailing address

1901 STEPHENSON MILL RD
VERONA KY
41092-9313
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-4981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007485
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: