Provider Demographics
NPI:1891853917
Name:BROWN, JEFFREY HUGH (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HUGH
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 1:1175 BAKER ST
Mailing Address - Street 2:E-16
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4101
Mailing Address - Country:US
Mailing Address - Phone:714-979-1811
Mailing Address - Fax:
Practice Address - Street 1:1175 BAKER ST
Practice Address - Street 2:E-16
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4101
Practice Address - Country:US
Practice Address - Phone:714-979-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8065T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0080650Medicaid
CASD0080650Medicaid