Provider Demographics
NPI:1093874430
Name:BROWNSTEIN, MERYL (OD)
Entity Type:Individual
Prefix:DR
First Name:MERYL
Middle Name:
Last Name:BROWNSTEIN
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 1:122 E PUTNAM AVE
Mailing Address - Street 2:FLOOR - 2 WEST
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2720
Mailing Address - Country:US
Mailing Address - Phone:203-661-2255
Mailing Address - Fax:203-661-3903
Practice Address - Street 1:122 E PUTNAM AVE
Practice Address - Street 2:FLOOR - 2 WEST
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2720
Practice Address - Country:US
Practice Address - Phone:203-661-2255
Practice Address - Fax:203-661-3903
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0400450001Medicare ID - Type UnspecifiedOPTOMETRY - DURABLE MEDIC
CTT23507Medicare UPIN
CT41000323Medicare ID - Type UnspecifiedOPTOMETRY