Provider Demographics
NPI:1013920107
Name:CAROL L. BROWN O.D., INC.
Entity Type:Organization
Organization Name:CAROL L. BROWN O.D., INC.
Other - Org Name:PERSONAL EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-885-5300
Mailing Address - Street 1:8254 MAYBERRY SQ N
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9457
Mailing Address - Country:US
Mailing Address - Phone:419-885-5300
Mailing Address - Fax:419-885-5308
Practice Address - Street 1:8254 MAYBERRY SQ N
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9457
Practice Address - Country:US
Practice Address - Phone:419-885-5300
Practice Address - Fax:419-885-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3926T9152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0507080001Medicare NSC
OHCA9348181Medicare PIN