Provider Demographics
NPI:1770645525
Name:BROWN, GEORGE J (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
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 1:400 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3807
Mailing Address - Country:US
Mailing Address - Phone:401-438-4447
Mailing Address - Fax:401-438-0160
Practice Address - Street 1:400 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3807
Practice Address - Country:US
Practice Address - Phone:401-438-4447
Practice Address - Fax:401-438-0160
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI483-TG152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
RI483- TG152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200150OtherBLUE CHIP
RI26473-6OtherBLUE CROSS BLUE SHIELD
RI7003136Medicaid
RI7003136Medicaid