Provider Demographics
NPI:1154199933
Name:BROWN, MONIQUE L (OPTICIAN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MRS
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:24554 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1031
Mailing Address - Country:US
Mailing Address - Phone:248-818-6702
Mailing Address - Fax:
Practice Address - Street 1:24554 GROVE AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1031
Practice Address - Country:US
Practice Address - Phone:248-818-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician