Provider Demographics
NPI:1417128166
Name:BROWN VISION CENTER TOBY J BROWN OD
Entity Type:Organization
Organization Name:BROWN VISION CENTER TOBY J BROWN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-995-4102
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-0474
Mailing Address - Country:US
Mailing Address - Phone:806-995-4102
Mailing Address - Fax:806-995-3216
Practice Address - Street 1:317 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088-0474
Practice Address - Country:US
Practice Address - Phone:806-995-4102
Practice Address - Fax:806-995-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5379T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275640001Medicare NSC
TX00208EMedicare PIN
TXU67449Medicare UPIN