Provider Demographics
NPI:1265508576
Name:BROWN, AMY MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:BROWN
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 1:421 PIONEER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4948
Mailing Address - Country:US
Mailing Address - Phone:530-661-0300
Mailing Address - Fax:530-661-0501
Practice Address - Street 1:421 PIONEER AVE STE B
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4948
Practice Address - Country:US
Practice Address - Phone:530-661-0300
Practice Address - Fax:530-661-0501
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 11043T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0110430Medicaid
MB0689034OtherDEA NUMBER
U85361Medicare UPIN
MB0689034OtherDEA NUMBER