S. Mack Brown OD Optometric Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

4748T Issued in CA

Legal business name

S. MACK BROWN OD OPTOMETRIC CORPORATION

Practice address

716 S Dora St
Ukiah, CA 95482-5336

Phone

(707) 462-5361

Fax

(707) 462-2457

NPI assigned

Jul 11, 2014

Organization subpart

No

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

Authorized official

Name

Dr. S. Mack Brown, OD

Title

President

Phone

(707) 462-5361

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405036800000",
    "number": "1679989594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825336",
            "telephone_number": "707-462-5361",
            "fax_number": "707-462-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954825336",
            "telephone_number": "707-462-5361",
            "fax_number": "707-462-2457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S. MACK BROWN OD OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2014-07-11",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "S. MACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-462-5361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "4748T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1 IDENTIFIER",
            "identifier": "1679628994",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Ukiah, CA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.