Provider Demographics
NPI:1578938247
Name:BROGDEN EYE & ASSOCIATES LLC
Entity Type:Organization
Organization Name:BROGDEN EYE & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BROGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-679-5286
Mailing Address - Street 1:8160 RANDOLPH WAY
Mailing Address - Street 2:#404
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4911
Mailing Address - Country:US
Mailing Address - Phone:410-419-3836
Mailing Address - Fax:
Practice Address - Street 1:2600 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1626
Practice Address - Country:US
Practice Address - Phone:443-679-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty