Healthcare Provider Details

I. General information

NPI: 1427670256
Provider Name (Legal Business Name): JACOB LLOYD BROWN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 LEXINGTON AVE
MANSFIELD OH
44907-2675
US

IV. Provider business mailing address

1260 LEXINGTON AVE
MANSFIELD OH
44907-2675
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-8204
  • Fax:
Mailing address:
  • Phone: 419-571-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00676900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006863
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: