MEDICARE: DR. JOEL I 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	0-869	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0620530001	OTHER	ID	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000010015436	OTHER	ID	REGENCE

General Provider Information

NPI Number	:	1891780334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL I BROWN O.D.

Provider Business Mailing Address
First Line	:	622 W NORTH ST
Second Line	:
City	:	GRANGEVILLE
State	:	ID
Zip	:	83530-1240
Country	:	US
Telephone Number	:	208-983-0260
Fax Number	:	208-983-0047

Provider Business Practice Location Address
First Line	:	622 W NORTH ST
Second Line	:
City	:	GRANGEVILLE
State	:	ID
Zip	:	83530-1240
Country	:	US
Telephone Number	:	208-983-0260
Fax Number	:	208-983-0047

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	02/13/2008

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