Provider Demographics
NPI:1619083714
Name:BROWN, KEVIN LLOYD (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LLOYD
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907
Mailing Address - Country:US
Mailing Address - Phone:419-756-8204
Mailing Address - Fax:419-756-0286
Practice Address - Street 1:1260 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907
Practice Address - Country:US
Practice Address - Phone:419-756-8204
Practice Address - Fax:419-756-0286
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 4548 T1291152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2019069Medicaid
U68615Medicare UPIN
OHBRO838551Medicare ID - Type Unspecified
OH2019069Medicaid