Provider Demographics
NPI:1497966923
Name:BROWN, BARBARA WILLIS (OD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:WILLIS
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2533 WOODSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5436
Mailing Address - Country:US
Mailing Address - Phone:314-423-3874
Mailing Address - Fax:888-423-0074
Practice Address - Street 1:1592 COUNTRY CLUB PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3859
Practice Address - Country:US
Practice Address - Phone:636-949-2900
Practice Address - Fax:636-949-2270
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02948152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11769916OtherCAQH
MOTO2948OtherMISSOURI LICENSE
MO261067928Medicare PIN