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General NPI Number Information
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NPI Number | 1598781007
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Entity Type | Individual
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Provider Name | TRISTAN M BROWN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 1236 HEIRES AVE
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City | CARROLL
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State | IA
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Zip | 51401-3328
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Country | US
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Telephone | 712-792-3318
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Fax | 712-792-3319
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | CARROLL
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State | IA
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Zip | 51401-0669
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Country | US
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Telephone | 712-792-3318
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Fax | 712-792-3319
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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 | 02359
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License Number State | IA
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