Provider Demographics
NPI:1972114908
Name:ELLIOTT BRODBAKER, MD, PLLC
Entity Type:Organization
Organization Name:ELLIOTT BRODBAKER, MD, PLLC
Other - Org Name:NEXTGEN EYE SURGEONS OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-998-3554
Mailing Address - Street 1:670 W CAMPBELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3358
Mailing Address - Country:US
Mailing Address - Phone:469-998-3554
Mailing Address - Fax:
Practice Address - Street 1:670 W CAMPBELL RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3358
Practice Address - Country:US
Practice Address - Phone:972-889-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty