Provider Demographics
NPI:1164422044
Name:BROWN, COY A (OPTOMERISTS)
Entity Type:Individual
Prefix:DR
First Name:COY
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:OPTOMERISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BOWMAN DR
Mailing Address - Street 2:STE C
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-6115
Mailing Address - Country:US
Mailing Address - Phone:828-456-3211
Mailing Address - Fax:
Practice Address - Street 1:18 BOWMAN DR
Practice Address - Street 2:SUITE C
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28785-6115
Practice Address - Country:US
Practice Address - Phone:828-456-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09116OtherBLUE CROSS & BLUE SHIELD
NC8909116Medicaid
NC8909116Medicaid
NC246399Medicare ID - Type Unspecified