Provider Demographics
NPI:1396719720
Name:BROWN, DAVID THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 DELANO AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2276
Mailing Address - Country:US
Mailing Address - Phone:740-772-1105
Mailing Address - Fax:740-772-1105
Practice Address - Street 1:217 DELANO AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2276
Practice Address - Country:US
Practice Address - Phone:740-772-1105
Practice Address - Fax:740-772-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5376152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNC2014OtherEYEMED
OH26-3729715OtherVISION PLUS
OH263729715OtherVISION SERVICE PLAN (VSP)
OH3028262Medicaid
OHNC2014OtherEYEMED
OH26-3729715OtherVISION PLUS
OHV10229Medicare UPIN