Provider Demographics
NPI:1134298672
Name:BROWN, ALLEN W
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 GOLF DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1426
Mailing Address - Country:US
Mailing Address - Phone:713-650-1036
Mailing Address - Fax:
Practice Address - Street 1:2000 CRAWFORD ST
Practice Address - Street 2:STE 842
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9070
Practice Address - Country:US
Practice Address - Phone:713-650-1036
Practice Address - Fax:713-651-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR0353156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
917986OtherAMERIGROUP BLOCK VISION
TX019958002Medicaid