Provider Demographics
NPI:1821145475
Name:BROZA, DANIEL JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:BROZA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5312 FOUNDATION ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2867
Mailing Address - Country:US
Mailing Address - Phone:757-746-2014
Mailing Address - Fax:757-746-2046
Practice Address - Street 1:12121 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6916
Practice Address - Country:US
Practice Address - Phone:757-746-2014
Practice Address - Fax:757-746-2046
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist