Provider Demographics
NPI:1962444596
Name:ELTON H. BROWN III OD PC
Entity Type:Organization
Organization Name:ELTON H. BROWN III OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:434-447-7400
Mailing Address - Street 1:113 E ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-2001
Mailing Address - Country:US
Mailing Address - Phone:434-447-7400
Mailing Address - Fax:434-447-4660
Practice Address - Street 1:113 E ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2001
Practice Address - Country:US
Practice Address - Phone:434-447-7400
Practice Address - Fax:434-447-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821049941OtherINDIVIDUAL NPI
VA071537OtherANTHEM
VA1821049941OtherINDIVIDUAL NPI
VA071537OtherANTHEM
VAT93306Medicare UPIN
VA410000383Medicare PIN