Provider Demographics
NPI:1639144298
Name:BROWN, JAMES M (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:344 E ARCH ST
Mailing Address - Street 2:P.O. BOX 490
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2102
Mailing Address - Country:US
Mailing Address - Phone:270-821-2862
Mailing Address - Fax:270-825-2200
Practice Address - Street 1:344 E ARCH ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2102
Practice Address - Country:US
Practice Address - Phone:270-821-2862
Practice Address - Fax:270-825-2200
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY739D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77007391Medicaid
KYT78560Medicare UPIN
KY77007391Medicaid