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General NPI Number Information
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NPI Number | 1255144044
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Entity Type | Organization
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Legal Business Name | BROWN FAMILY RETINA
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 6760 GOODMAN RD STE 125
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-9893
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Country | US
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Telephone | 662-782-5404
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Fax | 662-405-0345
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Provider Business Mailing Address
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Address Line | 6760 GOODMAN RD STE 125
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-9893
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Country | US
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Telephone | 662-782-5404
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Fax | 662-405-0345
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Authorized Official
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Title or Position | SURGEON
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Name | CALVIN CHRISTOPHER BROWN
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Credential | MD
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Telephone | 662-782-5404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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