Provider Demographics
NPI:1013033067
Name:BROWN, ROBERT ELI (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELI
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:545 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5215
Mailing Address - Country:US
Mailing Address - Phone:570-714-5665
Mailing Address - Fax:570-714-5660
Practice Address - Street 1:693 W MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3422
Practice Address - Country:US
Practice Address - Phone:570-714-5665
Practice Address - Fax:570-714-5660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004419T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17290OtherGEISINGER HEALTH PLAN
PA284812OtherBLUE CROSS BLUE SHIELD
PA5107010OtherAETNA
PA51425OtherDAVIS VISION
PA397424OtherNVA
PA816929OtherFIRST PRIORITY HEALTH
PA42844OtherSPECTERA
PAPA693OtherVBA
PA397424OtherNVA