Provider Demographics
NPI:1588652242
Name:BROWN, CHARLES K (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
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 1:3165 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5262
Mailing Address - Country:US
Mailing Address - Phone:205-967-2103
Mailing Address - Fax:205-967-2119
Practice Address - Street 1:3165 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-5262
Practice Address - Country:US
Practice Address - Phone:205-967-2103
Practice Address - Fax:205-967-2119
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS462TA018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030624Medicaid
AL000030624Medicare PIN
AL000030624Medicaid
T69143Medicare UPIN
AL30624Medicare ID - Type Unspecified