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General NPI Number Information
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NPI Number | 1942373485
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Entity Type | Individual
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Provider Name | NICHOLE YVONNE BROWN O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 4605 US HIGHWAY 17 STE 1
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4829
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Country | US
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Telephone | 904-269-8161
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Fax | 904-215-4633
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Provider Business Mailing Address
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Address Line | 1844 LAKE FOREST LN
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-8626
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Country | US
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Telephone | 904-269-8161
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Fax |
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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 | OPC3321
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License Number State | FL
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