Provider Demographics
NPI:1871602771
Name:DR RYAN J BROWN PC
Entity type:Organization
Organization Name:DR RYAN J BROWN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-576-1261
Mailing Address - Street 1:1202 2ND AVE N
Mailing Address - Street 2:PO BOX 1016
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4115
Mailing Address - Country:US
Mailing Address - Phone:515-576-1261
Mailing Address - Fax:515-576-0224
Practice Address - Street 1:1202 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4115
Practice Address - Country:US
Practice Address - Phone:515-576-1261
Practice Address - Fax:515-576-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34895OtherBLUE CROSS BLUE SHIELD
IA05379OtherBLUE CROSS BLUE SHIELD
IA0463158Medicaid
IA5486680001Medicare NSC
IAI15550Medicare PIN