Provider Demographics
NPI:1457646226
Name:JEFFREY H BROWN OPTOMETRY P C
Entity Type:Organization
Organization Name:JEFFREY H BROWN OPTOMETRY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-979-1811
Mailing Address - Street 1:1175 BAKER ST
Mailing Address - Street 2:E-16
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4101
Mailing Address - Country:US
Mailing Address - Phone:714-979-1811
Mailing Address - Fax:714-979-2025
Practice Address - Street 1:1175 BAKER ST
Practice Address - Street 2:E-16
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4101
Practice Address - Country:US
Practice Address - Phone:714-979-1811
Practice Address - Fax:714-979-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8065T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0080650Medicaid