Provider Demographics
NPI:1760460364
Name:BROWNFIELD, MICHAEL JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BROWNFIELD
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 1:3887 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5256
Mailing Address - Country:US
Mailing Address - Phone:724-539-1900
Mailing Address - Fax:724-532-1464
Practice Address - Street 1:801 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1827
Practice Address - Country:US
Practice Address - Phone:724-539-1900
Practice Address - Fax:724-532-1464
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101516829Medicaid
PAP00925634Medicare PIN
PA101516829Medicaid