Provider Demographics
NPI:1144491242
Name:BROWN EYECARE PA
Entity type:Organization
Organization Name:BROWN EYECARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-269-8161
Mailing Address - Street 1:4605 US HIGHWAY 17
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4829
Mailing Address - Country:US
Mailing Address - Phone:904-269-8161
Mailing Address - Fax:904-215-4633
Practice Address - Street 1:4605 US HIGHWAY 17
Practice Address - Street 2:SUITE 1
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4829
Practice Address - Country:US
Practice Address - Phone:904-269-8161
Practice Address - Fax:904-215-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3321152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3131Medicare PIN