Provider Demographics
NPI:1457387664
Name:BROWNFIELD, JERI M (OD)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:M
Last Name:BROWNFIELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:2424 HIGHWAY 6 AND 50
Practice Address - Street 2:SPACE 306
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1109
Practice Address - Country:US
Practice Address - Phone:970-257-1427
Practice Address - Fax:970-257-8148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95389750Medicaid
T34780Medicare UPIN