Provider Demographics
NPI:1568450039
Name:BROEDER, CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:BROEDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4203
Mailing Address - Country:US
Mailing Address - Phone:314-726-0070
Mailing Address - Fax:314-726-0070
Practice Address - Street 1:7410 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4203
Practice Address - Country:US
Practice Address - Phone:314-726-0070
Practice Address - Fax:314-726-0070
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37922Medicare UPIN