Provider Demographics
NPI:1750330635
Name:BROWN, CAROL L (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8254 MAYBERRY SQ N
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-885-5300
Mailing Address - Fax:419-885-5308
Practice Address - Street 1:8254 MAYBERRY SQ N
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-885-5300
Practice Address - Fax:419-885-5308
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3926T9152W00000X
MI4901003141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000136272OtherANTHEM
OH0975253Medicaid
OH03068OtherPARAMOUNT
OH0507080001Medicare NSC
OH000000136272OtherANTHEM
OH0975253Medicaid