Healthcare Provider Details

I. General information

NPI: 1770639742
Provider Name (Legal Business Name): DR. BERTRAM M. BROWN, OPTOMETRIST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941A NINE MILE RD
RICHMOND VA
23223-5738
US

IV. Provider business mailing address

4941A NINE MILE RD
RICHMOND VA
23223-5738
US

V. Phone/Fax

Practice location:
  • Phone: 804-222-0557
  • Fax: 804-236-9398
Mailing address:
  • Phone: 804-222-0557
  • Fax: 804-236-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618000573
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number0618000573
License Number StateVA

VIII. Authorized Official

Name: DR. BERTRAM MAXWELL BROWN
Title or Position: OWNER
Credential: O. D.
Phone: 804-222-0557