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General NPI Number Information
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NPI Number | 1861635161
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Entity Type | Organization
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Legal Business Name | DIANE BROWN, O.D. P.A.
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 13490 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32224-0290
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Country | US
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Telephone | 904-992-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 13218 ARABELLA DR
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City | JACKSONVILLE
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State | FL
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Zip | 32224-1355
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Country | US
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Telephone | 904-565-1662
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DR. DIANE BROWN
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Credential | O.D.
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Telephone | 904-992-4100
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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 | OPC 3642
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License Number State | FL
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