Provider Demographics
NPI:1154590909
Name:BROWN FAMILY VISION, P.C.
Entity type:Organization
Organization Name:BROWN FAMILY VISION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-983-0260
Mailing Address - Street 1:622 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1240
Mailing Address - Country:US
Mailing Address - Phone:208-983-0260
Mailing Address - Fax:
Practice Address - Street 1:622 W NORTH ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1240
Practice Address - Country:US
Practice Address - Phone:208-983-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
ID0-869332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002182800Medicaid
IDV7201OtherBLUE CROSS
ID000010015436OtherREGENCE
IDV7201OtherBLUE CROSS
ID000010015436OtherREGENCE
IDU41396Medicare UPIN