Provider Demographics
NPI:1275558322
Name:BROWN, RONALD CRAIG SR (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CRAIG
Last Name:BROWN
Suffix:SR
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 1:1911 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6122
Mailing Address - Country:US
Mailing Address - Phone:843-662-3912
Mailing Address - Fax:843-662-3912
Practice Address - Street 1:1911 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6122
Practice Address - Country:US
Practice Address - Phone:843-662-3912
Practice Address - Fax:843-667-4550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC00657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1275558322OtherRONALD C BROWN SR NPI
SCD06571Medicaid
SCD06571Medicare UPIN
SC0875650001Medicare NSC
SCT248160282Medicare PIN