Active NPI
Jerry W Brown, O.D.
- Optometrist
- Waynesville, MO
National Provider Identifier
1265545412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T03398MO
- Practice address
- 1390 Highway F
Waynesville, MO 65583 - Phone
- (573) 774-2040
- Fax
- (573) 774-6152
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T03398MO | MO | Primary |
Addresses
Primary practice location
1390 Highway F
Waynesville, MO 65583
Mailing address
1390 Highway F
Waynesville, MO 65583
Phone (573) 774-2040
Other identifiers 46
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0431157294 | Other | MO | UNITED COMMERCIAL TRAVELERS OF AMERICA |
| 1598945859 | Other | MO | BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM |
| 1598945859 | Other | MO | MERITAIN HEALTH |
| 431157294 | Other | MO | UNITEDHEALTHCARE |
| 431157294 | Other | MO | ANTHEM BLUECROSS BLUESHIELD |
| 596488 | Other | MO | COVENTRY HEALTH AND LIFE INSURANCE COMPANY |
| 1598945859 | Other | MO | BLUE SHIELD OF CALIFORNIA |
| 1598945859 | Other | MO | AMERICAN REPUBLIC INSURANCE COMPANY |
| 431157294 | Other | MO | UMR |
| 431157294 A | Other | MO | HUMANA |
| 1598945859 | Other | MO | COOPERATIVE BENEFIT ADMINISTRATORS, INC |
| 1598945859 | Other | MO | CHAMPVA |
| 2195676 | Other | MO | MAIL HANDLERS BENEFIT PLAN |
| 410046201 | Other | MO | PALMETTO GBA - RAILROAD MEDICARE |
| 431157294 0005 | Other | MO | CIGNA |
| 000000414171 | Other | MO | ANTHEM |
| 002000052183 | Other | MO | CARE IMPROVEMENT PLUS |
| 002613709 | Other | MO | APWU HEALTH PLAN |
| 1265545412 | Medicaid | MN | |
| 1598945859 | Other | MO | PALMETTO GBA - RAILROAD MEDICARE |
| 431157294 | Other | MO | CORESOURCE |
| 431157294 | Other | MO | EQUITABLE LIFE AND CASUALTY INSURANCE COMPANY |
| 431157294 | Other | MO | MEDICO INSURANCE COMPANY |
| 1598945859 | Other | MO | UNITED WORLD LIFE INSURANCE |
| 1598945859 | Other | MO | BLUE CROSS BLUE SHIELD OF MINNESOTA |
| 1598945859 | Other | MO | CONTINENTAL LIFE INSURANCE |
| 1598945859 | Other | MO | NATIONAL ASSOCIATIO OF LETTER CARRIERS HEALTH BENEFIT |
| 431157294-X01 | Other | MO | OLD SURETY LIFE INSURANCE COMPANY |
| 0007812292 | Other | MO | AETNA |
| 1598945859 | Other | MO | HARTFORD LIFE INSURANCE COMPANY |
| 1598945859 | Other | MO | EQUITABLE LIFE AND CASUALTY INSURANCE COMPANY |
| 1598945859 | Other | MO | COMBINED INSURANCE COMPANY OF AMERICA |
| 1598945859 | Other | MO | CARPENTERS' HEALTH & WELFARE TRUST FUND OF ST. LOUIS |
| 431157294 | Other | MO | HEARTLAND NATIONAL |
| 431157294 | Other | MO | ARCADIAN COMMUNITY CARE |
| 431157294 | Other | MO | TRANSAMERICA LIFE INSURANCE COMPANY |
| 1265545412 | Other | MO | WPS TRICARE |
| 1598945859 | Other | MO | CHRISTIAN FIDELITY LIFE INSURANCE COMPANY |
| 1598945859 | Other | MO | CONSTRUCTION INDUSTRY LABORERES WELFARE FUND |
| 1598945859 | Other | MO | AMERICAN FAMILY INSURANCE |
| 431157294 | Other | MO | RESERVE NATIONAL |
| 1265545412 | Other | MO | TRICARE WEST |
| 1598945859 | Other | MO | MUTUAL OF OMAHA COMPANIES |
| 1598945859 | Other | MO | ADMIRAL LIFE INSURANCE COMPANY OF AMERICA |
| 1598945859 | Other | MO | PHYSICIANS MUTUAL |
| 1598945859 | Other | MO | GOVERNMENT EMPLOYEES HEALTH ASSOCIATION INC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T03398MO | MO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420502400000",
"number": "1265545412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1390 HIGHWAY F",
"city": "WAYNESVILLE",
"state": "MO",
"postal_code": "65583",
"telephone_number": "573-774-2040",
"fax_number": "573-774-6152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1390 HIGHWAY F",
"city": "WAYNESVILLE",
"state": "MO",
"postal_code": "65583",
"telephone_number": "573-774-2040",
"fax_number": "573-774-6152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "JERRY",
"middle_name": "W",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2015-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T03398MO",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED COMMERCIAL TRAVELERS OF AMERICA",
"identifier": "0431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
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"identifier": "1598945859",
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},
{
"code": "01",
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},
{
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},
{
"code": "01",
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"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CALIFORNIA",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
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"state": "MO"
},
{
"code": "01",
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"issuer": "UMR",
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"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "431157294 A",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COOPERATIVE BENEFIT ADMINISTRATORS, INC",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPVA",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAIL HANDLERS BENEFIT PLAN",
"identifier": "2195676",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA - RAILROAD MEDICARE",
"identifier": "410046201",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "431157294 0005",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000414171",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE IMPROVEMENT PLUS",
"identifier": "002000052183",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "APWU HEALTH PLAN",
"identifier": "002613709",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1265545412",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA - RAILROAD MEDICARE",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORESOURCE",
"identifier": "431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EQUITABLE LIFE AND CASUALTY INSURANCE COMPANY",
"identifier": "431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICO INSURANCE COMPANY",
"identifier": "431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED WORLD LIFE INSURANCE",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF MINNESOTA",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTINENTAL LIFE INSURANCE",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL ASSOCIATIO OF LETTER CARRIERS HEALTH BENEFIT",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OLD SURETY LIFE INSURANCE COMPANY",
"identifier": "431157294-X01",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007812292",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARTFORD LIFE INSURANCE COMPANY",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EQUITABLE LIFE AND CASUALTY INSURANCE COMPANY",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMBINED INSURANCE COMPANY OF AMERICA",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARPENTERS' HEALTH & WELFARE TRUST FUND OF ST. LOUIS",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEARTLAND NATIONAL",
"identifier": "431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARCADIAN COMMUNITY CARE",
"identifier": "431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRANSAMERICA LIFE INSURANCE COMPANY",
"identifier": "431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WPS TRICARE",
"identifier": "1265545412",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHRISTIAN FIDELITY LIFE INSURANCE COMPANY",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONSTRUCTION INDUSTRY LABORERES WELFARE FUND",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN FAMILY INSURANCE",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RESERVE NATIONAL",
"identifier": "431157294",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE WEST",
"identifier": "1265545412",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MUTUAL OF OMAHA COMPANIES",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADMIRAL LIFE INSURANCE COMPANY OF AMERICA",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS MUTUAL",
"identifier": "1598945859",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GOVERNMENT EMPLOYEES HEALTH ASSOCIATION INC",
"identifier": "1598945859",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waynesville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.