Provider Demographics
NPI:1790848687
Name:BROWN, DALE JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:318 TUSCULUM BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-3926
Mailing Address - Country:US
Mailing Address - Phone:423-639-4171
Mailing Address - Fax:423-639-5442
Practice Address - Street 1:318 TUSCULUM BLVD STE 2
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3926
Practice Address - Country:US
Practice Address - Phone:423-639-4171
Practice Address - Fax:423-639-5442
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000000510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN55617OtherTENNCARE AND BCBS ID#
TN38691OtherDAVIS VISION ID#
TNTN0510OtherEYEMED ID#
TN62-0888706OtherOPTICARE ID#
TN62-0888706OtherOPTICARE ID#
TN55617OtherTENNCARE AND BCBS ID#
TNUO1114Medicare UPIN