Provider Demographics
NPI:1447364005
Name:BROWN, JAMES EDWARD (O D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:BROWN
Suffix:
Gender:M
Credentials:O D
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 988
Mailing Address - Street 2:208 W CALHOUN
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-0988
Mailing Address - Country:US
Mailing Address - Phone:662-983-2323
Mailing Address - Fax:662-983-4126
Practice Address - Street 1:208 W CALHOUN ST
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-0988
Practice Address - Country:US
Practice Address - Phone:662-983-2323
Practice Address - Fax:662-983-4126
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880002Medicaid
MSU27095Medicare UPIN