Provider Demographics
NPI:1053483313
Name:BROWN, LAURA K (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12313 LAVINA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6489
Mailing Address - Country:US
Mailing Address - Phone:661-204-2488
Mailing Address - Fax:
Practice Address - Street 1:4101 EMPIRE DR STE 120
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0681
Practice Address - Country:US
Practice Address - Phone:661-325-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14117T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200018200-AMedicaid
OK20406OtherSPECTERA PROVIDER NUMBER
OK200018200-AMedicaid