Provider Demographics
NPI:1568462919
Name:COY A BROWN, OD PA
Entity Type:Organization
Organization Name:COY A BROWN, OD PA
Other - Org Name:SMOKY MTN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-456-3211
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:LAKE JUNALUSKA
Mailing Address - State:NC
Mailing Address - Zip Code:28745-0100
Mailing Address - Country:US
Mailing Address - Phone:828-456-3211
Mailing Address - Fax:828-246-6064
Practice Address - Street 1:18 BOWMAN DR
Practice Address - Street 2:SUITE C
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28785-6115
Practice Address - Country:US
Practice Address - Phone:828-456-3211
Practice Address - Fax:828-246-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909116Medicaid
NC09116OtherBLUE CROSS & BLUE SHIELD
NC8909116Medicaid
NC09116OtherBLUE CROSS & BLUE SHIELD