Healthcare Provider Details

I. General information

NPI: 1154590909
Provider Name (Legal Business Name): BROWN FAMILY VISION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W NORTH ST
GRANGEVILLE ID
83530-1240
US

IV. Provider business mailing address

622 W NORTH ST
GRANGEVILLE ID
83530-1240
US

V. Phone/Fax

Practice location:
  • Phone: 208-983-0260
  • Fax:
Mailing address:
  • Phone: 208-983-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number0-869
License Number StateID

VIII. Authorized Official

Name: JOEL I BROWN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 208-983-0260