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General NPI Number Information
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NPI Number | 1548398159
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Entity Type | Organization
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Legal Business Name | ELTON H. BROWN III OD PC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 315 N MAIN ST
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-1809
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Country | US
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Telephone | 434-848-2411
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Fax | 434-848-0193
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Provider Business Mailing Address
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Address Line | 315 N MAIN ST
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-1809
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Country | US
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Telephone | 434-848-2411
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Fax | 434-848-0193
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELTON H. BROWN
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Credential | OD
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Telephone | 434-447-7400
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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 | 0618000431
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License Number State | VA
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