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General NPI Number Information
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NPI Number | 1730578212
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Entity Type | Organization
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Legal Business Name | DANIEL J BROZA, O.D., PLLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 12121 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-6916
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Country | US
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Telephone | 757-746-2014
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Fax | 757-746-2046
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Provider Business Mailing Address
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Address Line | 5312 FOUNDATION ST
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2867
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Country | US
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Telephone | 757-345-0975
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Fax | 757-746-2046
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DANIEL BROZA
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Credential | O.D.
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Telephone | 757-345-0975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0618000779
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License Number State | VA
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