Provider Demographics
NPI:1376539916
Name:BROWN, JERARD W (OD)
Entity Type:Individual
Prefix:DR
First Name:JERARD
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1982
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:679 KIDDER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6908
Practice Address - Country:US
Practice Address - Phone:570-825-3491
Practice Address - Fax:570-822-5654
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016537180006Medicaid
PABR1691698OtherHIGHMARK BLUE SHIELD
PA0016537180006Medicaid
PABR1691698OtherHIGHMARK BLUE SHIELD