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General NPI Number Information
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NPI Number | 1447327432
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Entity Type | Individual
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Provider Name | KENNETH L BROWN OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18110 W BLUEMOUND RD STOP 3
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City | BROOKFIELD
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State | WI
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Zip | 53045-2917
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Country | US
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Telephone | 262-796-2020
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Fax | 262-796-0504
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Provider Business Mailing Address
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Address Line | 18110 W BLUEMOUND RD STOP 3
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City | BROOKFIELD
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State | WI
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Zip | 53045-2917
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Country | US
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Telephone | 262-796-2020
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Fax | 262-796-0504
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | WI2800
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License Number State | WI
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