Provider Demographics
NPI:1922077916
Name:BRODMANN, DOROTHY ANN (OD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANN
Last Name:BRODMANN
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 1:1950 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:571-223-6780
Practice Address - Street 1:5399 WILLISTON RD STE 102
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-5321
Practice Address - Country:US
Practice Address - Phone:802-864-5428
Practice Address - Fax:802-864-1288
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA618000255152W00000X
VTVT0300000300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN3922Medicare ID - Type Unspecified
V24848Medicare UPIN