Provider Demographics
NPI:1821049941
Name:BROWN, ELTON HOWARD III (OD)
Entity Type:Individual
Prefix:DR
First Name:ELTON
Middle Name:HOWARD
Last Name:BROWN
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:129 E FERRELL ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2101
Practice Address - Country:US
Practice Address - Phone:434-447-3220
Practice Address - Fax:434-447-2309
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009232702Medicaid
VA071537OtherANTHEM BC BS
VA009203575Medicaid
VA101715OtherANTHEM BC BS
VA101715OtherANTHEM BC BS
VAT93306Medicare UPIN
VA410000383Medicare PIN
VA410000923Medicare PIN