MEDICARE: BROWN FAMILY VISION, P.C.

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	332H00000X	Eyewear Supplier	0-869	ID
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	V7201	OTHER	ID	BLUE CROSS
3	000010015436	OTHER	ID	REGENCE

General Provider Information

NPI Number	:	1154590909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWN FAMILY VISION, P.C.

Provider Business Mailing Address
First Line	:	622 W NORTH ST
Second Line	:
City	:	GRANGEVILLE
State	:	ID
Zip	:	83530-1240
Country	:	US
Telephone Number	:	208-983-0260
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 W NORTH ST
Second Line	:
City	:	GRANGEVILLE
State	:	ID
Zip	:	83530-1240
Country	:	US
Telephone Number	:	208-983-0260
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEL I BROWN
Credential	:	O.D.
Telephone Number	:	208-983-0260

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	05/17/2012

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