Provider Demographics
NPI:1487702064
Name:BROWN, WILLIAM VERNON (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VERNON
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:V
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:43124 HIGHWAY 299E
Mailing Address - City:FALL RIVER MILLS
Mailing Address - State:CA
Mailing Address - Zip Code:96028-0787
Mailing Address - Country:US
Mailing Address - Phone:530-336-5220
Mailing Address - Fax:
Practice Address - Street 1:43124 HIGHWAY 299E
Practice Address - Street 2:
Practice Address - City:FALL RIVER MILLS
Practice Address - State:CA
Practice Address - Zip Code:96028
Practice Address - Country:US
Practice Address - Phone:530-336-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8202 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12600OtherMES IDENTIFICATION NUMBER
CASD0082020Medicaid
CA0225710001Medicare NSC
CASD0082020Medicare PIN
CASD0082020Medicaid