Provider Demographics
NPI:1639294614
Name:RICHARD H. BRODTMANN, O.D.
Entity type:Organization
Organization Name:RICHARD H. BRODTMANN, O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HILAIRE
Authorized Official - Last Name:BRODTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-629-1248
Mailing Address - Street 1:101 IH 35 WEST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-629-1248
Mailing Address - Fax:
Practice Address - Street 1:101 IH 35 WEST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-629-1248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2507T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019973901Medicaid