Provider Demographics
NPI:1053408575
Name:MYERS, BREN ALDEN (OD)
Entity type:Individual
Prefix:DR
First Name:BREN
Middle Name:ALDEN
Last Name:MYERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N MILL
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-3239
Mailing Address - Country:US
Mailing Address - Phone:785-738-3816
Mailing Address - Fax:785-738-4320
Practice Address - Street 1:124 N MILL
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-3239
Practice Address - Country:US
Practice Address - Phone:785-738-3816
Practice Address - Fax:785-738-4320
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1039-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090890DMedicaid
KS100090890DMedicaid
KS651096Medicare ID - Type Unspecified