Provider Demographics
NPI:1396810859
Name:BROWN, JOHN CHARLES (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
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:PO BOX 916
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0916
Mailing Address - Country:US
Mailing Address - Phone:425-455-4602
Mailing Address - Fax:425-709-6879
Practice Address - Street 1:10220 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4217
Practice Address - Country:US
Practice Address - Phone:425-455-4602
Practice Address - Fax:425-709-6879
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB39899Medicare ID - Type Unspecified
WAT32222Medicare UPIN