Provider Demographics
NPI:1356329908
Name:BROWN, RICHARD LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
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:PO BOX 5076
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5076
Mailing Address - Country:US
Mailing Address - Phone:308-384-0220
Mailing Address - Fax:308-382-1650
Practice Address - Street 1:420 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4979
Practice Address - Country:US
Practice Address - Phone:308-384-0220
Practice Address - Fax:308-382-1650
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8383OtherMIDLANDS CHOICE
06970OtherBLUECROSS BLUESHIELD
087585Medicare ID - Type Unspecified
06970OtherBLUECROSS BLUESHIELD