Provider Demographics
NPI:1417988080
Name:FLOYD, BRENDA C (OD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:FLOYD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:C
Other - Last Name:BROCHETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2410 S STEMMONS FWY
Practice Address - Street 2:STE E
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8777
Practice Address - Country:US
Practice Address - Phone:972-315-5202
Practice Address - Fax:972-315-3083
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02832T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13288Medicare UPIN
TX00764ZMedicare ID - Type Unspecified