MEDICARE: KALA BROWN BREWER 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	2358	NC

General Provider Information

NPI Number	:	1699116723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALA BROWN BREWER O.D.

Provider Business Mailing Address
First Line	:	PO BOX 388
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-0388
Country	:	US
Telephone Number	:	336-835-1312
Fax Number	:	336-835-9911

Provider Business Practice Location Address
First Line	:	346 N BRIDGE ST
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-3407
Country	:	US
Telephone Number	:	336-835-1312
Fax Number	:	336-835-9911

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	12/03/2021

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