Healthcare Provider Details

I. General information

NPI: 1457646226
Provider Name (Legal Business Name): JEFFREY H BROWN OPTOMETRY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 BAKER ST E-16
COSTA MESA CA
92626-4101
US

IV. Provider business mailing address

1175 BAKER ST E-16
COSTA MESA CA
92626-4101
US

V. Phone/Fax

Practice location:
  • Phone: 714-979-1811
  • Fax: 714-979-2025
Mailing address:
  • Phone: 714-979-1811
  • Fax: 714-979-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number8065T
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY H BROWN
Title or Position: OWNER
Credential: O.D
Phone: 714-979-1811