Provider Demographics
NPI:1912566753
Name:BROWN, THOMAS JR (OD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:139 RITCHIE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1152
Mailing Address - Country:US
Mailing Address - Phone:410-544-7417
Mailing Address - Fax:410-544-4408
Practice Address - Street 1:139 RITCHIE HIGHWAY
Practice Address - Street 2:SUITE B
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-544-7417
Practice Address - Fax:410-544-4408
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2671OtherLICENSE NUMBER