Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC004116 | FL |
NPI | 1013208016 |
---|---|
Provider Name | Dr. Scott Mervyn Brown |
First Address | Coconut Creek, FL 33073-2320 |
Second Address | Pompano Beach, FL 33064-3542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 25/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OPC004116 | OPTOMERIST STATE LICENSE (01) | FL |