Provider Demographics
NPI:1053366096
Name:BROWN, TOBY JAY (OD)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:JAY
Last Name:BROWN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-0474
Mailing Address - Country:US
Mailing Address - Phone:806-995-4102
Mailing Address - Fax:806-995-3216
Practice Address - Street 1:317 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088-0474
Practice Address - Country:US
Practice Address - Phone:806-995-4102
Practice Address - Fax:806-995-3216
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5379T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E412OtherBCBS
TX1275640001Medicare NSC
TX00208EMedicare PIN
U67449Medicare UPIN