Healthcare Provider Details

I. General information

NPI: 1194842971
Provider Name (Legal Business Name): SCOTT F BROWNE, O.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 KENOWA AVE SW
GRANDVILLE MI
49418-9523
US

IV. Provider business mailing address

2327 KINNROW AVE NW
GRAND RAPIDS MI
49534-1287
US

V. Phone/Fax

Practice location:
  • Phone: 616-667-9717
  • Fax:
Mailing address:
  • Phone: 616-735-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901002738
License Number StateMI

VIII. Authorized Official

Name: DR. SCOTT F BROWNE
Title or Position: OPTOMETRIC PHYSICIAN
Credential: O.D.
Phone: 616-735-0656