Most Relevant Information
Provider Data
| NPI Number: | 1003393539 |
| Provider Name: | ALEXIS NOELLE BROUSSARD OD |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | 2085 |
Most Important Dates
| Enumeration Date: | 07/26/2018 |
| Last Updated: | 07/26/2018 |
Provider Practice Location
280 HARBISON BLVD STE T
COLUMBIA
SC
292122247
Practice Location Phone/Fax
| Phone: | 8037329200 |
| Fax: |
Provider Mailing Location
8704 SOUTHAMPTON DR
MIRAMAR
FL
330252716
Provider Mailing Phone/Fax
| Phone: | 5044810472 |
| Fax: |