Provider Demographics
NPI:1245360866
Name:KENT T BROWN OD, PC
Entity type:Organization
Organization Name:KENT T BROWN OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-322-5959
Mailing Address - Street 1:P.O. BOX 779
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-0779
Mailing Address - Country:US
Mailing Address - Phone:406-322-5959
Mailing Address - Fax:
Practice Address - Street 1:621 EAST 4TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-7198
Practice Address - Country:US
Practice Address - Phone:406-322-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENT T BROWN OD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0180100002OtherDME PTAN
MT1245360866Medicaid
MTM011001793Medicare PIN