Provider Demographics
NPI:1497130702
Name:BROBERG, MATTHEW COURY (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:COURY
Last Name:BROBERG
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 1:11754 GARNETT ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3449
Mailing Address - Country:US
Mailing Address - Phone:785-320-0998
Mailing Address - Fax:
Practice Address - Street 1:1221 PENNSYLVANIA AVE APT 2206
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1447
Practice Address - Country:US
Practice Address - Phone:816-533-5336
Practice Address - Fax:816-817-3769
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015032220152W00000X
CO0003144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist