Provider Demographics
NPI:1477559599
Name:BROWNING, GREGORY ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:BROWNING
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 1:912 OAK ST
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1423
Mailing Address - Country:US
Mailing Address - Phone:304-453-4072
Mailing Address - Fax:304-453-6172
Practice Address - Street 1:912 OAK ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1423
Practice Address - Country:US
Practice Address - Phone:304-453-4072
Practice Address - Fax:304-453-6172
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV015010600Medicaid
KYK333OtherBLUE CROSS
9163261Medicare PIN
T32552Medicare UPIN