Most Relevant Information
Provider Data
| NPI Number: | 1003814096 |
| Provider Name: | MICHELLE A. BRODERICK O.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | OPT767 |
Most Important Dates
| Enumeration Date: | 07/13/2005 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
82 MAINE ST
BRUNSWICK
ME
040112015
Practice Location Phone/Fax
| Phone: | 2077298474 |
| Fax: | 2077298955 |
Provider Mailing Location
82 MAINE ST
BRUNSWICK
ME
040112015
Provider Mailing Phone/Fax
| Phone: | 2077298474 |
| Fax: | 2077298955 |