Healthcare Provider Details

I. General information

NPI: 1992729149
Provider Name (Legal Business Name): MICHAEL DWAYNE BROWN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GOVERNORS DRIVE VA CBOC, UAB MEDICAL BUILDING
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

911 CORLEY DR SE
HUNTSVILLE AL
35802-3700
US

V. Phone/Fax

Practice location:
  • Phone: 256-535-3100
  • Fax: 256-534-1580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR-128-TA-424
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: