Provider Demographics
NPI:1831247584
Name:BROWN, KENT T (OD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:T
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 779
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-0779
Mailing Address - Country:US
Mailing Address - Phone:406-322-5959
Mailing Address - Fax:
Practice Address - Street 1:621 EAST 4TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-7198
Practice Address - Country:US
Practice Address - Phone:406-322-5959
Practice Address - Fax:406-322-5959
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011001794Medicare PIN