Provider Demographics
NPI:1174548382
Name:BREAR, DAVID RUSSELL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
Last Name:BREAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 SUNSET LN STE E
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3942
Mailing Address - Country:US
Mailing Address - Phone:540-825-3655
Mailing Address - Fax:540-825-5574
Practice Address - Street 1:633 SUNSET LN STE E
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3942
Practice Address - Country:US
Practice Address - Phone:540-825-3655
Practice Address - Fax:540-825-5574
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037434207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006300081Medicaid
VA180000454Medicare ID - Type Unspecified
VA006300081Medicaid