Brown Family Vision, P.C.
Organization Active NPI Optometrist · Grangeville, ID
NPI 1154590909 · NPPES record last updated May 17, 2012
Key facts
- NPI
- 1154590909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- BROWN FAMILY VISION, P.C.
- Practice address
- 622 W North St
Grangeville, ID 83530-1240 - Phone
- (208) 983-0260
- NPI assigned
- Feb 26, 2008
- Organization subpart
- No
Authorized official
- Name
- Joel I Brown, O.D.
- Title
- President
- Phone
- (208) 983-0260
Practitioners 1
-
Joel I Brown, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Brown Family Vision |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101014001252 | ID | DME Supplier - Physician - Optometrist | 2264625870 | Practice locations: Grangeville, ID |
| O20120120000583 | ID | Part B Supplier - Clinic/Group Practice | 2264625870 |
Receives reassigned benefits from 1 practitioner Practice locations: Grangeville, ID |
National Provider Directory
Locations
622 W North St
Grangeville, ID 83530
Phone (208) 903-0260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Eyewear Supplier | 332H00000X | 0-869 | ID |
Addresses
Primary practice location
622 W North St
Grangeville, ID 83530-1240
Mailing address
622 W North St
Grangeville, ID 83530-1240
Phone (208) 983-0260
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002182800 | Medicaid | ID | |
| V7201 | Other | ID | BLUE CROSS |
| 000010015436 | Other | ID | REGENCE |
Other providers in Grangeville, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.