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Organization
S. MACK BROWN OD OPTOMETRIC CORPORATION
Active
Organization
S. MACK BROWN OD OPTOMETRIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. S. MACK BROWN OD (PRESIDENT)
(707) 462-5361
Entity
Organization
Contact information
Practice address
716 S DORA ST, UKIAH, CA 95482-5336
(707) 462-5361
(707) 462-2457
Mailing address
716 S DORA ST, UKIAH, CA 95482-5336
(707) 462-5361
(707) 462-2457
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4748T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679628994
NPI TYPE 1 IDENTIFIER
CA
Enumeration date
07/11/2014
Last updated
07/11/2014
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