Provider Demographics
NPI:1508938812
Name:BROWN, JAMES R (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:BERT
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-0555
Mailing Address - Country:US
Mailing Address - Phone:662-837-3696
Mailing Address - Fax:662-837-0004
Practice Address - Street 1:220 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2054
Practice Address - Country:US
Practice Address - Phone:662-837-3696
Practice Address - Fax:662-837-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087780Medicaid
MSMS0450OtherEYEMED
MS640619201OtherFED EMPLOY I D
MS0415290001Medicare NSC
MS00087780Medicaid
MS560945499Medicare PIN