Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DR0353 | TX |
NPI | 1134298672 |
---|---|
Provider Name | Allen W Brown |
First Address | Houston, TX 77018-1426 |
Second Address | Houston, TX 77002-9070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 02/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019958002 | (05) | TX |
917986 | AMERIGROUP BLOCK VISION (01) |