Provider Demographics
NPI:1679626543
Name:BROWN, JAMES BRENT (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRENT
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 1:101 S DAWSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3301
Mailing Address - Country:US
Mailing Address - Phone:170-688-5061
Mailing Address - Fax:706-885-9129
Practice Address - Street 1:101 S DAWSON ST STE B
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3301
Practice Address - Country:US
Practice Address - Phone:170-688-5061
Practice Address - Fax:706-885-9129
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT2100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist