Provider Demographics
NPI:1063842003
Name:BROWN, KOLMAN (OD)
Entity type:Individual
Prefix:DR
First Name:KOLMAN
Middle Name:
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 130
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NY
Mailing Address - Zip Code:12421-0130
Mailing Address - Country:US
Mailing Address - Phone:607-326-7891
Mailing Address - Fax:
Practice Address - Street 1:505 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2015
Practice Address - Country:US
Practice Address - Phone:718-622-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist