Provider Demographics
NPI:1952450439
Name:BROBST, ANNE NEUBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:NEUBERT
Last Name:BROBST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:NEUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:385 FAIRPOINTE PL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6899
Mailing Address - Country:US
Mailing Address - Phone:770-886-6925
Mailing Address - Fax:
Practice Address - Street 1:11460 JOHNS CREEK PKWY
Practice Address - Street 2:CIBA VISION CORPORATION
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1518
Practice Address - Country:US
Practice Address - Phone:678-415-3779
Practice Address - Fax:678-415-2713
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist