Provider Demographics
NPI:1174511786
Name:BRODSKY, ERIC L (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SW COLLEGE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4436
Mailing Address - Country:US
Mailing Address - Phone:352-237-3798
Mailing Address - Fax:352-237-5235
Practice Address - Street 1:2701 SW COLLEGE RD STE 105
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4436
Practice Address - Country:US
Practice Address - Phone:352-237-3798
Practice Address - Fax:352-237-5235
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086868000Medicaid
FL20430Medicare ID - Type Unspecified
FLU-41672Medicare UPIN