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General NPI Number Information
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NPI Number | 1003138041
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Entity Type | Organization
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Legal Business Name | BROSTER JD LLC
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 8701 MAITLAND SUMMIT BLVD
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City | ORLANDO
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State | FL
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Zip | 32810-5915
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Country | US
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Telephone | 407-385-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 MAITLAND SUMMIT BOULEVARD
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City | ORLANDO
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State | FL
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Zip | 32810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | KATIE E ROMANO
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Credential |
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Telephone | 407-902-6419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME101588
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License Number State | FL
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