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General NPI Number Information
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NPI Number | 1649253410
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Entity Type | Individual
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Provider Name | LARRY RAY BROWN O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/24/2005
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 101 MARKET PLACE BLVD
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2236
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Country | US
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Telephone | 770-386-9022
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Fax | 770-382-3188
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Provider Business Mailing Address
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Address Line | 101 MARKET PLACE BLVD
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2236
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Country | US
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Telephone | 770-386-9022
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Fax | 770-382-3188
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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 | 1436
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License Number State | GA
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