Provider Demographics
NPI:1982631792
Name:BROOME, FRANK ANTHONY JR (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANTHONY
Last Name:BROOME
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:701 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5331
Mailing Address - Country:US
Mailing Address - Phone:386-253-5999
Mailing Address - Fax:386-253-1193
Practice Address - Street 1:3781 S NOVA RD STE O
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4285
Practice Address - Country:US
Practice Address - Phone:386-760-8626
Practice Address - Fax:386-760-2676
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC795152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084399700Medicaid
FL19811VMedicare PIN
FL084399700Medicaid