Provider Demographics
NPI:1598978157
Name:GENE BROWN OPTICIANS LLC
Entity Type:Organization
Organization Name:GENE BROWN OPTICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-445-8636
Mailing Address - Street 1:2101 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7632
Mailing Address - Country:US
Mailing Address - Phone:573-445-8636
Mailing Address - Fax:573-446-9122
Practice Address - Street 1:2101 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7632
Practice Address - Country:US
Practice Address - Phone:573-445-8636
Practice Address - Fax:573-446-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10050400332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8096OtherHEALTHCARE USA
MO0549470002Medicare ID - Type Unspecified