Provider Demographics
NPI:1225118102
Name:BROWN, WILLIAM S (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BRYANT AVE APT 3AD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1927
Mailing Address - Country:US
Mailing Address - Phone:646-522-9266
Mailing Address - Fax:
Practice Address - Street 1:2550 WEBB AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3930
Practice Address - Country:US
Practice Address - Phone:646-522-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004840-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P675652OtherOXFORD
0049092OtherGHI
76719OtherAETNA
NY01099045Medicaid
NY1225118102OtherMAGNACARE
4778805OtherCIGNA
76719OtherUS HEALTH CARE
C-32441OtherBLUE CROSSBLUE SHIELD
901509OtherUNITED HEALTH CARE
185222POtherHIP
1C9763OtherMULTIPLAN
T-49044Medicare UPIN
NY1225118102OtherMAGNACARE