MEDICARE: DEAN RANDOLPH 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	2302ATI	OR

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	807295000	OTHER	OR	REGENCE BLUE CROSS

General Provider Information

NPI Number	:	1497751275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN RANDOLPH BROWN O.D.

Provider Business Mailing Address
First Line	:	650 E PINE ST
Second Line	:	STE 105
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-2482
Country	:	US
Telephone Number	:	541-664-5535
Fax Number	:	541-664-7745

Provider Business Practice Location Address
First Line	:	650 E PINE ST
Second Line	:	STE 105
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-2482
Country	:	US
Telephone Number	:	541-664-5535
Fax Number	:	541-664-7745

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	09/10/2009

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