MEDICARE: DR. FRANK ANTHONY BROOME JR. O.D.

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	OPC795	FL
2	152W00000X	Optometrist	OPC795	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982631792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK ANTHONY BROOME JR. O.D.

Provider Business Mailing Address
First Line	:	701 S RIDGEWOOD AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5331
Country	:	US
Telephone Number	:	386-253-5999
Fax Number	:	386-253-1193

Provider Business Practice Location Address
First Line	:	3781 S NOVA RD STE O
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4285
Country	:	US
Telephone Number	:	386-760-8626
Fax Number	:	386-760-2676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	04/12/2018

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