Active NPI
Larry Ray Brown, O.D.
- Optometrist
- Cartersville, GA
National Provider Identifier
1649253410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1436
- Practice address
- 101 Market Place Blvd
Cartersville, GA 30121-2236 - Phone
- (770) 386-9022
- Fax
- (770) 382-3188
- NPI assigned
- Nov 24, 2005
- Sex
- Male
- Sole proprietor
- No
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 | 1436 | GA | Primary |
Addresses
Primary practice location
101 Market Place Blvd
Cartersville, GA 30121-2236
Mailing address
101 Market Place Blvd
Cartersville, GA 30121-2236
Phone (770) 386-9022
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00787355A | Medicaid | GA |
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 |
|---|---|---|---|
| 1436 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313366400000",
"number": "1649253410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 MARKET PLACE BLVD",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301212236",
"telephone_number": "770-386-9022",
"fax_number": "770-382-3188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 MARKET PLACE BLVD",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301212236",
"telephone_number": "770-386-9022",
"fax_number": "770-382-3188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "LARRY",
"middle_name": "RAY",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-24",
"last_updated": "2011-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "1436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00787355A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cartersville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.