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General NPI Number Information
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NPI Number | 1164404109
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Entity Type | Organization
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Legal Business Name | T L BROWN OD PC
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 117 E LINCOLNWAY ST
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City | JEFFERSON
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State | IA
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Zip | 50129-2107
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Country | US
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Telephone | 515-386-8196
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Fax | 515-386-2380
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Provider Business Mailing Address
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Address Line | PO BOX 460
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City | JEFFERSON
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State | IA
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Zip | 50129-0460
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Country | US
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Telephone | 515-386-8196
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Fax | 515-386-2380
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRY L BROWN
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Credential | O.D.
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Telephone | 515-386-8196
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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 |
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License Number State |
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