Healthcare Provider Details

I. General information

NPI: 1508809559
Provider Name (Legal Business Name): AMANDA LEIGH BROWN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 CROSSHILL BLVD
JACKSONVILLE FL
32222-5812
US

IV. Provider business mailing address

30 TAVERNIER DR UNIT C
PONTE VEDRA FL
32081-0677
US

V. Phone/Fax

Practice location:
  • Phone: 904-573-9482
  • Fax: 904-573-9945
Mailing address:
  • Phone: 904-686-2897
  • Fax: 904-834-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC4100
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: