Provider Demographics
NPI:1619916871
Name:BROWN, KEVIN M (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
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 1:11 SHRINER ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-1155
Mailing Address - Country:US
Mailing Address - Phone:605-624-2020
Mailing Address - Fax:605-624-7961
Practice Address - Street 1:11 SHRINER ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-1155
Practice Address - Country:US
Practice Address - Phone:605-624-2020
Practice Address - Fax:605-624-7961
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201660Medicaid
SD0822130001Medicare NSC
SDS101294Medicare PIN
SDT66673Medicare UPIN