Provider Demographics
NPI:1881958437
Name:BROWN, KATHRYN LEEANN (OD)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LEEANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LEEANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:115 AUDUBON DR.
Mailing Address - Street 2:STE 8
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7409
Mailing Address - Country:US
Mailing Address - Phone:501-803-3962
Mailing Address - Fax:501-803-3962
Practice Address - Street 1:115 AUDUBON DR.
Practice Address - Street 2:STE 8
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7409
Practice Address - Country:US
Practice Address - Phone:501-803-3962
Practice Address - Fax:501-803-3962
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2909152W00000X
AR2681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist