Healthcare Provider Details

I. General information

NPI: 1689848582
Provider Name (Legal Business Name): ROBERT A BROWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 LONG POND RD
ROCHESTER NY
14626-1146
US

IV. Provider business mailing address

880 LONG POND RD
ROCHESTER NY
14626-1146
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-7030
  • Fax: 585-227-9986
Mailing address:
  • Phone: 585-227-7030
  • Fax: 585-227-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT003965
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT A BROWN
Title or Position: OWNER
Credential: OD
Phone: 585-227-7030