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General NPI Number Information
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NPI Number | 1770942070
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Entity Type | Organization
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Legal Business Name | BROWN EYE CARE LLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 6633 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2253
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Country | US
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Telephone | 215-422-3636
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Fax | 215-422-3748
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Provider Business Mailing Address
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Address Line | 615 S CONESTOGA ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANTHY BROWN
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Credential | OD
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Telephone | 215-626-5619
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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 | OEGOO2168
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License Number State | PA
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