Organization
TIMOTHY M BROWN, OD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY MICHAEL BROWN OD (PRESIDENT)
(618) 263-3165
Entity
Organization
Contact information
Practice address
715 WALNUT ST, MOUNT CARMEL, IL 62863-1465
(618) 263-3165
Mailing address
715 WALNUT ST, MOUNT CARMEL, IL 62863-1465
(618) 263-3165
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008505
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046008505
MEDICARE SUPPLIER
IL
05
—
046008505
—
IL
01
—
209199
MEDICARE GROUP
IL
Enumeration date
08/05/2007
Last updated
02/13/2014
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