Healthcare Provider Details

I. General information

NPI: 1386920031
Provider Name (Legal Business Name): THEODORE AVERY BROWN L.D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189A WARLEY ST
FLORENCE SC
29501-4442
US

IV. Provider business mailing address

P.O. BOX 3851
FLORENCE SC
29502
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-0888
  • Fax: 843-669-4197
Mailing address:
  • Phone: 843-669-0888
  • Fax: 843-669-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number145
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number514
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: