Healthcare Provider Details

I. General information

NPI: 1164422044
Provider Name (Legal Business Name): COY A BROWN OPTOMERISTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BOWMAN DR SUITE C
WAYNESVILLE NC
28785-6115
US

IV. Provider business mailing address

18 BOWMAN DR STE C
WAYNESVILLE NC
28785-6115
US

V. Phone/Fax

Practice location:
  • Phone: 828-456-3211
  • Fax:
Mailing address:
  • Phone: 828-456-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNC 1041
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: