Provider Demographics
NPI:1730224247
Name:BROWN'S OPTICAL, INC.
Entity type:Organization
Organization Name:BROWN'S OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-651-3403
Mailing Address - Street 1:530 BUSHY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2995
Mailing Address - Country:US
Mailing Address - Phone:860-651-3403
Mailing Address - Fax:860-651-5919
Practice Address - Street 1:530 BUSHY HILL RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2995
Practice Address - Country:US
Practice Address - Phone:860-651-3403
Practice Address - Fax:860-651-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1390332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0592910001Medicare NSC
CT0592910001Medicare ID - Type UnspecifiedOPTICAL