Provider Demographics
NPI:1740251065
Name:BROWN, KIM COURTNEY (OD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:COURTNEY
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:COURTNEY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:13440 W ALAMEDA PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5601
Mailing Address - Country:US
Mailing Address - Phone:303-985-1549
Mailing Address - Fax:303-985-1540
Practice Address - Street 1:13440 W ALAMEDA PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-5601
Practice Address - Country:US
Practice Address - Phone:303-985-1549
Practice Address - Fax:303-985-1540
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42893Medicare ID - Type Unspecified
COU16988Medicare UPIN