Provider Demographics
NPI:1811980949
Name:BROWN, MARK C (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-9331
Mailing Address - Country:US
Mailing Address - Phone:304-429-6527
Mailing Address - Fax:
Practice Address - Street 1:3333 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2838
Practice Address - Country:US
Practice Address - Phone:304-522-2551
Practice Address - Fax:304-522-2544
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 740 OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2244OtherSPECTERA INSURANCE
WV0150722000Medicaid
WV48693OtherDAVIS VISION