Provider Demographics
NPI:1548441272
Name:BROWN, AMY G (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:G
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:GOWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2301 PINE RUN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8328
Mailing Address - Country:US
Mailing Address - Phone:803-240-2698
Mailing Address - Fax:
Practice Address - Street 1:1151 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6555
Practice Address - Country:US
Practice Address - Phone:803-802-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist