Provider Demographics
NPI:1184699571
Name:BROWN, JEFFREY DAVID (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:BROWN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N HOGAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4203
Mailing Address - Country:US
Mailing Address - Phone:904-757-1495
Mailing Address - Fax:904-757-1497
Practice Address - Street 1:5255 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4361
Practice Address - Country:US
Practice Address - Phone:904-757-1495
Practice Address - Fax:904-757-1497
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7223289OtherAETNA
2615561OtherUHC
8677011OtherCIGNA
0135179OtherGHI
FLP00424970OtherMEDICARE RR PTAN
FL621210700OtherMEDICAID INDIVIDUAL ID
FL01029OtherBCBS INDIVIDUAL ID
8677011OtherCIGNA
FLU6918ZMedicare PIN
2615561OtherUHC