MEDICARE: GRETCHEN J BREWER, OD & ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1354192	OTHER	PA	PERSONAL CHOICE BLUE CHOI
3	2051170000	OTHER	PA	KEYSTONE HEALTHPLAN EAST
4	2988538	OTHER	PW	AETNA
5	GR1354192	OTHER	PA	PA BLUE SHIELD

General Provider Information

NPI Number	:	1386731727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRETCHEN J BREWER, OD & ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	2329 COTTMAN AVE
Second Line	:	ROOSEVELT MALL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149
Country	:	US
Telephone Number	:	215-332-7228
Fax Number	:	215-332-9337

Provider Business Practice Location Address
First Line	:	2329 COTTMAN AVE
Second Line	:	ROOSEVELT MALL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149
Country	:	US
Telephone Number	:	215-332-7228
Fax Number	:	215-332-9337

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	GRETCHEN J BREWER
Credential	:	OD
Telephone Number	:	215-332-7228

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	05/29/2014

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