Provider Demographics
NPI:1023388550
Name:DR REBECCA J W BROWN LLC
Entity Type:Organization
Organization Name:DR REBECCA J W BROWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-332-1200
Mailing Address - Street 1:389 N ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2805
Mailing Address - Country:US
Mailing Address - Phone:330-332-1200
Mailing Address - Fax:330-332-1200
Practice Address - Street 1:389 N ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2805
Practice Address - Country:US
Practice Address - Phone:330-332-1200
Practice Address - Fax:330-332-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H083571Medicare PIN
V08795Medicare UPIN