Provider Demographics
NPI:1992786354
Name:BROWN, TERRY L (OD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-0460
Mailing Address - Country:US
Mailing Address - Phone:515-386-8196
Mailing Address - Fax:515-386-8921
Practice Address - Street 1:117 E LINCOLNWAY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2107
Practice Address - Country:US
Practice Address - Phone:515-386-8196
Practice Address - Fax:515-386-8921
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01160OtherWELLMARK BC/BS J
IA3091728Medicaid
IA0091728Medicaid
IA026715OtherHEALTH ALLIANCE JEFFERSON
IA73120OtherCOVENTRY OSCEOLA
IA41542OtherWELLMARK BC/BS OSCEOLA
IA35344OtherMIDLANDS CHOICE
IA72859OtherCOVENTRY JEFFERSON
IA0091728Medicaid
IA41542OtherWELLMARK BC/BS OSCEOLA
IA35344OtherMIDLANDS CHOICE
IAT00125Medicare UPIN
IAI7565Medicare PIN