Provider Demographics
NPI:1912221961
Name:DAVID T. BROWN, O.D.
Entity Type:Organization
Organization Name:DAVID T. BROWN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-772-1105
Mailing Address - Street 1:217 DELANO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2276
Mailing Address - Country:US
Mailing Address - Phone:740-772-1105
Mailing Address - Fax:740-772-1105
Practice Address - Street 1:217 DELANO AVE STE D
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2276
Practice Address - Country:US
Practice Address - Phone:740-772-1105
Practice Address - Fax:740-772-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5376T2287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3028262Medicaid
OH1396719720OtherMEDICAL MUTUAL
OH1396719720OtherMEDICAL MUTUAL
OH3028262Medicaid
OHBR4264452Medicare PIN
OH6273190001Medicare NSC
OH=========OtherVISION SERVICE PLAN (VSP)