Provider Demographics
NPI:1497706808
Name:BROWN, DANIEL T (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
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 1:502 E. NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5427
Mailing Address - Country:US
Mailing Address - Phone:321-727-2020
Mailing Address - Fax:321-984-9547
Practice Address - Street 1:502 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5427
Practice Address - Country:US
Practice Address - Phone:321-727-2020
Practice Address - Fax:321-984-9547
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20409OtherBLUE CROSS / BLUE SHIELD
FL5962549OtherAETNA PPO
FL2527938OtherAETNA HMO
FL410040081OtherRAILROAD MEDICARE
FL070214500Medicaid
FLT90026Medicare UPIN
FL070214500Medicaid