Provider Demographics
NPI:1912025164
Name:BROWDY, BETH ROBIN (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ROBIN
Last Name:BROWDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 GRANT RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3279
Mailing Address - Country:US
Mailing Address - Phone:650-961-9290
Mailing Address - Fax:650-961-9289
Practice Address - Street 1:1350 GRANT RD
Practice Address - Street 2:SUITE 16
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3279
Practice Address - Country:US
Practice Address - Phone:650-961-9290
Practice Address - Fax:650-961-9289
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6877T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0068770Medicare ID - Type Unspecified
CAU25217Medicare UPIN