Healthcare Provider Details

I. General information

NPI: 1992786354
Provider Name (Legal Business Name): TERRY L BROWN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E LINCOLNWAY ST
JEFFERSON IA
50129-2107
US

IV. Provider business mailing address

PO BOX 460
JEFFERSON IA
50129-0460
US

V. Phone/Fax

Practice location:
  • Phone: 515-386-8196
  • Fax: 515-386-8921
Mailing address:
  • Phone: 515-386-8196
  • Fax: 515-386-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number01563
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: