Provider Demographics
NPI:1265545412
Name:BROWN, JERRY W (OD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:W
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1390 HIGHWAY F
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583
Mailing Address - Country:US
Mailing Address - Phone:573-774-2040
Mailing Address - Fax:573-774-6152
Practice Address - Street 1:1390 HIGHWAY F
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-774-2040
Practice Address - Fax:573-774-6152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03398MO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0431157294OtherUNITED COMMERCIAL TRAVELERS OF AMERICA
MO1598945859OtherBLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM
MO1598945859OtherMERITAIN HEALTH
MO431157294OtherUNITEDHEALTHCARE
MO431157294OtherANTHEM BLUECROSS BLUESHIELD
MO596488OtherCOVENTRY HEALTH AND LIFE INSURANCE COMPANY
MO1598945859OtherBLUE SHIELD OF CALIFORNIA
MO1598945859OtherAMERICAN REPUBLIC INSURANCE COMPANY
MO431157294OtherUMR
MO431157294 AOtherHUMANA
MO1598945859OtherCOOPERATIVE BENEFIT ADMINISTRATORS, INC
MO1598945859OtherCHAMPVA
MO2195676OtherMAIL HANDLERS BENEFIT PLAN
MO410046201OtherPALMETTO GBA - RAILROAD MEDICARE
MO431157294 0005OtherCIGNA
MO000000414171OtherANTHEM
MO002000052183OtherCARE IMPROVEMENT PLUS
MO002613709OtherAPWU HEALTH PLAN
MN1265545412Medicaid
MO1598945859OtherPALMETTO GBA - RAILROAD MEDICARE
MO431157294OtherCORESOURCE
MO431157294OtherEQUITABLE LIFE AND CASUALTY INSURANCE COMPANY
MO431157294OtherMEDICO INSURANCE COMPANY
MO1598945859OtherUNITED WORLD LIFE INSURANCE
MO1598945859OtherBLUE CROSS BLUE SHIELD OF MINNESOTA
MO1598945859OtherCONTINENTAL LIFE INSURANCE
MO1598945859OtherNATIONAL ASSOCIATIO OF LETTER CARRIERS HEALTH BENEFIT
MO431157294-X01OtherOLD SURETY LIFE INSURANCE COMPANY
MO0007812292OtherAETNA
MO1598945859OtherHARTFORD LIFE INSURANCE COMPANY
MO1598945859OtherEQUITABLE LIFE AND CASUALTY INSURANCE COMPANY
MO1598945859OtherCOMBINED INSURANCE COMPANY OF AMERICA
MO1598945859OtherCARPENTERS' HEALTH & WELFARE TRUST FUND OF ST. LOUIS
MO431157294OtherHEARTLAND NATIONAL
MO431157294OtherARCADIAN COMMUNITY CARE
MO431157294OtherTRANSAMERICA LIFE INSURANCE COMPANY
MO1265545412OtherWPS TRICARE
MO1598945859OtherCHRISTIAN FIDELITY LIFE INSURANCE COMPANY
MO1598945859OtherCONSTRUCTION INDUSTRY LABORERES WELFARE FUND
MO1598945859OtherAMERICAN FAMILY INSURANCE
MO431157294OtherRESERVE NATIONAL
MO1265545412OtherTRICARE WEST
MO1598945859OtherMUTUAL OF OMAHA COMPANIES
MO1598945859OtherADMIRAL LIFE INSURANCE COMPANY OF AMERICA
MO1598945859OtherPHYSICIANS MUTUAL
MO1598945859OtherGOVERNMENT EMPLOYEES HEALTH ASSOCIATION INC
MO2195676OtherMAIL HANDLERS BENEFIT PLAN
MO0354000001Medicare NSC