Provider Demographics
NPI:1548398159
Name:ELTON H. BROWN III OD PC
Entity Type:Organization
Organization Name:ELTON H. BROWN III OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-447-7400
Mailing Address - Street 1:315 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-1809
Mailing Address - Country:US
Mailing Address - Phone:434-848-2411
Mailing Address - Fax:434-848-0193
Practice Address - Street 1:315 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-1809
Practice Address - Country:US
Practice Address - Phone:434-848-2411
Practice Address - Fax:434-848-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821049941OtherNPI INDIVIDUAL
VA009232702Medicaid
VA101715OtherANTHEM
VA410000923Medicare PIN
VAT93306Medicare UPIN
VA009232702Medicaid