Provider Demographics
NPI:1275684979
Name:BROWN, EARL STANLEY (OD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:STANLEY
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:EARL
Other - Middle Name:S
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3612 AVE F
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414
Mailing Address - Country:US
Mailing Address - Phone:979-244-1450
Mailing Address - Fax:979-244-3122
Practice Address - Street 1:3612 AVE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414
Practice Address - Country:US
Practice Address - Phone:979-244-1450
Practice Address - Fax:979-244-3122
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2517T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020059401Medicaid
TX020059401Medicaid
T12417Medicare UPIN