Provider Demographics
NPI:1194786053
Name:BROWN, RANDY (OD)
Entity type:Individual
Prefix:DR
First Name:RANDY
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 1:11226 GOLD EXPRESS DR
Mailing Address - Street 2:STE 202
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-635-1037
Mailing Address - Fax:916-635-7370
Practice Address - Street 1:11226 GOLD EXPRESS DR
Practice Address - Street 2:STE 202
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-635-1037
Practice Address - Fax:916-635-7370
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA6850T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADV719ZOtherPTAN
CA680096203OtherBLUE SHIELD OF CALIFORNIA
CA680096203OtherAETNA
CA680096203OtherTRICARE WEST
CA680096203OtherBLUE CROSS OF CALIFORNIA
CA680096203OtherCIGNA HEALTH CARE
CASD0068500Medicaid
CA680096203OtherCIGNA HEALTH CARE
CASD0068500Medicare PIN
CASD0068500Medicaid