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General NPI Number Information
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NPI Number | 1013920107
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Entity Type | Organization
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Legal Business Name | CAROL L. BROWN O.D., INC.
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 8254 MAYBERRY SQ N
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City | SYLVANIA
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State | OH
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Zip | 43560-9457
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Country | US
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Telephone | 419-885-5300
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Fax | 419-885-5308
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Provider Business Mailing Address
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Address Line | 8254 MAYBERRY SQ N
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City | SYLVANIA
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State | OH
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Zip | 43560-9457
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Country | US
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Telephone | 419-885-5300
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Fax | 419-885-5308
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROL L. BROWN
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Credential | O.D.
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Telephone | 419-885-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3926T9
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License Number State | OH
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