Healthcare Provider Details

I. General information

NPI: 1922077916
Provider Name (Legal Business Name): DOROTHY ANN BRODMANN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5399 WILLISTON RD STE 102
WILLISTON VT
05495-5321
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3970
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-5428
  • Fax: 802-864-1288
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number618000255
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVT0300000300
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: