Provider Demographics
NPI:1164404109
Name:T L BROWN OD PC
Entity Type:Organization
Organization Name:T L BROWN OD PC
Other - Org Name:JEFFERSON EYE CARE, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-386-8196
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-0460
Mailing Address - Country:US
Mailing Address - Phone:515-386-8196
Mailing Address - Fax:515-386-2380
Practice Address - Street 1:117 E LINCOLNWAY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2107
Practice Address - Country:US
Practice Address - Phone:515-386-8196
Practice Address - Fax:515-386-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4210471460OtherHUMANA
IA0792242Medicaid
IA=========OtherUNICARE
IA=========OtherPRINCIPAL
IA=========OtherPYRAMID
IA=========OtherSECURE HORIZONS
IA4210471460OtherHUMANA
IA=========OtherMEDICARE COMPLETE
IA=========OtherADVANTRA
IA=========OtherADVANTRA
IA0203600001Medicare NSC
IA=========OtherVSP