Provider Demographics
NPI:1780672899
Name:BROWN, ROBERT TODD (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
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 1:900 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-1620
Mailing Address - Country:US
Mailing Address - Phone:319-350-4527
Mailing Address - Fax:515-602-6910
Practice Address - Street 1:900 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-1620
Practice Address - Country:US
Practice Address - Phone:319-350-4527
Practice Address - Fax:515-602-6910
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1946152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45823OtherWELLMARK BCBS OF IOWA
IAU19219Medicare UPIN
IAI8526Medicare ID - Type Unspecified