Healthcare Provider Details

I. General information

NPI: 1497751275
Provider Name (Legal Business Name): DEAN RANDOLPH BROWN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E PINE ST STE 105
CENTRAL POINT OR
97502-2482
US

IV. Provider business mailing address

650 E PINE ST STE 105
CENTRAL POINT OR
97502-2482
US

V. Phone/Fax

Practice location:
  • Phone: 541-664-5535
  • Fax: 541-664-7745
Mailing address:
  • Phone: 541-664-5535
  • Fax: 541-664-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2302ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: