MEDICARE: CAROL L. BROWN O.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3926T9	OH

General Provider Information

NPI Number	:	1013920107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL L. BROWN O.D., INC.

Provider Business Mailing Address
First Line	:	8254 MAYBERRY SQ N
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-9457
Country	:	US
Telephone Number	:	419-885-5300
Fax Number	:	419-885-5308

Provider Business Practice Location Address
First Line	:	8254 MAYBERRY SQ N
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-9457
Country	:	US
Telephone Number	:	419-885-5300
Fax Number	:	419-885-5308

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CAROL L. BROWN
Credential	:	O.D.
Telephone Number	:	419-885-5300

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	02/19/2008

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