MEDICARE: DR. PAMELA DIANE BROWN OD

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	4901003794	MI

General Provider Information

NPI Number	:	1649310616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA DIANE BROWN OD

Provider Business Mailing Address
First Line	:	22318 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2421
Country	:	US
Telephone Number	:	313-565-6565
Fax Number	:	313-565-0579

Provider Business Practice Location Address
First Line	:	22318 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2421
Country	:	US
Telephone Number	:	313-565-6565
Fax Number	:	313-565-0579

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	03/13/2010

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