MEDICARE: DR. SCOTT A BROWN O.D.

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	4901002954	MI

General Provider Information

NPI Number	:	1497709216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT A BROWN O.D.

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD STE 520
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	755 E CHICAGO ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-2027
Country	:	US
Telephone Number	:	517-278-9004
Fax Number	:	517-278-9007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/06/2021

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