Provider Demographics
NPI:1255144044
Name:BROWN FAMILY RETINA
Entity type:Organization
Organization Name:BROWN FAMILY RETINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-782-5404
Mailing Address - Street 1:6760 GOODMAN RD STE 125
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9893
Mailing Address - Country:US
Mailing Address - Phone:662-782-5404
Mailing Address - Fax:662-405-0345
Practice Address - Street 1:6760 GOODMAN RD STE 125
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9893
Practice Address - Country:US
Practice Address - Phone:662-782-5404
Practice Address - Fax:662-405-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery