Provider Demographics
NPI:1386630580
Name:BROWN, BARY M (OD)
Entity Type:Individual
Prefix:DR
First Name:BARY
Middle Name:M
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 1:1441 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1211
Mailing Address - Country:US
Mailing Address - Phone:417-886-2020
Mailing Address - Fax:417-886-9875
Practice Address - Street 1:1441 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1211
Practice Address - Country:US
Practice Address - Phone:417-886-2020
Practice Address - Fax:417-886-9875
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0435010001OtherDMERC REGION D
MO310817804Medicaid
MO410011386OtherRAILROAD MEDICARE
MOT42741Medicare UPIN
MO001008172Medicare ID - Type Unspecified