Provider Demographics
NPI:1245066414
Name:BRYAN BROWN, OD LLC
Entity type:Organization
Organization Name:BRYAN BROWN, OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-358-0471
Mailing Address - Street 1:1501 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8044
Mailing Address - Country:US
Mailing Address - Phone:334-333-3286
Mailing Address - Fax:501-328-9581
Practice Address - Street 1:3900 DAVE WARD DRIVE
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-358-0471
Practice Address - Fax:501-328-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty