Provider Demographics
NPI:1962431478
Name:BROWN, FREDERICK T (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:T
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 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:239-335-1944
Mailing Address - Fax:239-939-1575
Practice Address - Street 1:2500 TAMIAMI TRL N STE 109
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4421
Practice Address - Country:US
Practice Address - Phone:239-263-2700
Practice Address - Fax:239-263-2845
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19960CMedicare PIN
FLT85234Medicare UPIN