=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043454358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M.L. BROCHNER, M.D., P.C. VISUAL IMAGES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2009
-----------------------------------------------------
Last Update Date | 05/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4708 ALLIANCE BLVD SUITE 825
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-483-6727
-----------------------------------------------------
Fax | 214-483-6728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4708 ALLIANCE BLVD SUITE 825
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-483-6727
-----------------------------------------------------
Fax | 214-483-6728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHELLE BROCHNER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-483-6727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | L6001
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------