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General NPI Number Information
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NPI Number | 1396053740
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Entity Type | Organization
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Legal Business Name | BERTRAM M BROWN OD PC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 4941 A NINE MILE ROAD
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City | RICHMOND
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State | VA
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Zip | 23223-5738
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Country | US
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Telephone | 804-222-0557
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Fax | 804-236-9398
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Provider Business Mailing Address
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Address Line | 4941 A NINE MILE ROAD FAIRFIELD COMMONS SHOPPING CENTER
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City | RICHMOND
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State | VA
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Zip | 23223-5738
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Country | US
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Telephone | 804-222-0557
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Fax | 804-236-9398
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BERTRAM M BROWN
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Credential | O. D.
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Telephone | 804-222-0557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0618000573
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License Number State | VA
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