MEDICARE: BRODSKY & WEIKUM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	002243TG	TX
2	152W00000X	Optometrist	002243TG	TX

General Provider Information

NPI Number	:	1598889289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRODSKY & WEIKUM, INC

Provider Business Mailing Address
First Line	:	2100 ROSS AVE # 260LB4
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-2739
Country	:	US
Telephone Number	:	214-220-2425
Fax Number	:	214-220-2488

Provider Business Practice Location Address
First Line	:	2100 ROSS AVE # 260LB4
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-2739
Country	:	US
Telephone Number	:	214-220-2425
Fax Number	:	214-220-2488

Authorized Official
Title or Position	:	THERAPEUTIC OPTOMETRIST
Name	:	DR. ROGER ALLEN WEIKUM
Credential	:	O.D.
Telephone Number	:	214-220-2425

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/17/2011

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