Provider Demographics
NPI:1659368983
Name:BROTHERS, TAMARA J (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:J
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:866-795-4020
Practice Address - Street 1:3750 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3411
Practice Address - Country:US
Practice Address - Phone:757-486-1712
Practice Address - Fax:757-486-2962
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1616152W00000X
VA0618001535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890901KMedicaid
NC2470216Medicare ID - Type UnspecifiedCIGNA MEDICARE PROVIDER
NC890901KMedicaid