Provider Demographics
NPI:1497751275
Name:BROWN, DEAN RANDOLPH (OD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:RANDOLPH
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 1:650 E PINE ST
Mailing Address - Street 2:STE 105
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2482
Mailing Address - Country:US
Mailing Address - Phone:541-664-5535
Mailing Address - Fax:541-664-7745
Practice Address - Street 1:650 E PINE ST
Practice Address - Street 2:STE 105
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2482
Practice Address - Country:US
Practice Address - Phone:541-664-5535
Practice Address - Fax:541-664-7745
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2302ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029715Medicaid
OR807295000OtherREGENCE BLUE CROSS
ORU22973Medicare UPIN
OR410047151Medicare ID - Type UnspecifiedRAILROAD
OR807295000OtherREGENCE BLUE CROSS
OR029715Medicaid