MEDICARE: DR. CLIFFORD DOUGLAS 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	152WP0200X	Pediatric Optometrist	651	MT

General Provider Information

NPI Number	:	1649276106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFFORD DOUGLAS BROWN O.D.

Provider Business Mailing Address
First Line	:	3801 NEBRASKA AVE NW
Second Line	:	BLDG 20-106
City	:	WASHINGTON
State	:	DC
Zip	:	20008-0000
Country	:	US
Telephone Number	:	202-447-3813
Fax Number	:	202-282-8805

Provider Business Practice Location Address
First Line	:	3801 NEBRASKA AVE NW
Second Line	:	BLDG 20-106
City	:	WASHINGTON
State	:	DC
Zip	:	20008-0000
Country	:	US
Telephone Number	:	202-447-3813
Fax Number	:	202-282-8805

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	06/30/2011

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