Provider Demographics
NPI:1952304032
Name:BROWN, LARRY GARLAND (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GARLAND
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 1:2001 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3703
Mailing Address - Country:US
Mailing Address - Phone:904-355-5555
Mailing Address - Fax:904-355-9966
Practice Address - Street 1:2001 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3703
Practice Address - Country:US
Practice Address - Phone:904-355-5555
Practice Address - Fax:904-355-9966
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205295OtherAETNA HMO
FL621015500Medicaid
FLP00272233OtherRR MEDICARE
FL2201820OtherUNITED
FL28563OtherBCBS
FL299520OtherAVMED
FL1018387OtherCIGNA
FL5457809OtherAETNA
FL1205295OtherAETNA HMO
FL621015500Medicaid
FL299520OtherAVMED