MEDICARE: DR. BRETT MOWER OD

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	OD60367942	WA

General Provider Information

NPI Number	:	1689010811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT MOWER OD

Provider Business Mailing Address
First Line	:	1 JIM CLEMENTS WAY
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-1437
Country	:	US
Telephone Number	:	509-697-2020
Fax Number	:	509-697-6659

Provider Business Practice Location Address
First Line	:	105 W ORCHARD AVE
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-1329
Country	:	US
Telephone Number	:	509-697-2020
Fax Number	:	509-697-6659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	02/04/2020

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