Provider Demographics
NPI:1982633491
Name:BROWN, KIMBERLY M (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-987-3380
Mailing Address - Fax:866-806-3675
Practice Address - Street 1:50 UNION AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3262
Practice Address - Country:US
Practice Address - Phone:973-372-4000
Practice Address - Fax:973-372-4001
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00554400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7593309 01Medicaid
NJ011694Medicare ID - Type Unspecified
NJ7593309 01Medicaid