Provider Demographics
NPI:1972594323
Name:BROWN, BRYAN DOUGLAS (OD)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DOUGLAS
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 1:1501 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8044
Mailing Address - Country:US
Mailing Address - Phone:334-333-3286
Mailing Address - Fax:501-328-9581
Practice Address - Street 1:3900 DAVE WARD DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5583
Practice Address - Country:US
Practice Address - Phone:501-358-0471
Practice Address - Fax:501-328-9581
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR132TA436152W00000X
AR4020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051529114OtherBCBS
AL009999105Medicaid
ALU73161Medicare UPIN
AL051529114OtherBCBS
051529114Medicare PIN
ALCN3942Medicare PIN