Individual provider Active NPI

Robert Eli Brown, O.D.

  • Optometrist
  • Kingston, PA
National Provider Identifier
1013033067
Registry record updated Oct 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OE004419T Issued in PA
Practice address
693 W Market St
Kingston, PA 18704-3422
Phone
(570) 714-5665
Fax
(570) 714-5660
NPI assigned
Mar 21, 2007
Last updated
Oct 29, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OE004419T PA Primary

Addresses

Primary practice location

693 W Market St
Kingston, PA 18704-3422

Mailing address

545 Gibson Ave
Kingston, PA 18704-5215
Phone (570) 714-5665

Other identifiers 8

IdentifierTypeStateIssuer
17290OtherPAGEISINGER HEALTH PLAN
PA693OtherPAVBA
284812OtherPABLUE CROSS BLUE SHIELD
51425OtherPADAVIS VISION
816929OtherPAFIRST PRIORITY HEALTH
5107010OtherPAAETNA
42844OtherPASPECTERA
397424OtherPANVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040615000231 PA Practitioner - Optometry 5799769113 Practice locations: Kingston, PA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

693 W Market St
Kingston, PA 18704-3422
Phone (570) 714-5665

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225238400000",
    "number": "1013033067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 GIBSON AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045215",
            "telephone_number": "570-714-5665",
            "fax_number": "570-714-5660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "693 W MARKET ST",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043422",
            "telephone_number": "570-714-5665",
            "fax_number": "570-714-5660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "ROBERT",
        "middle_name": "ELI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2008-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OE004419T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "17290",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VBA",
            "identifier": "PA693",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "284812",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "51425",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "816929",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5107010",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "42844",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "397424",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, PA

Sources for this page

Verify at the official NPI Registry.