Provider Demographics
NPI:1801983598
Name:BROECKER, ERIC H (OD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:BROECKER
Suffix:
Gender:M
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:COLORADO EYE CENTER
Mailing Address - Street 2:10001 N WASHINGTON
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229
Mailing Address - Country:US
Mailing Address - Phone:303-451-8075
Mailing Address - Fax:303-457-9859
Practice Address - Street 1:COLORADO EYE CENTER
Practice Address - Street 2:10001 N WASHINGTON
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-451-8075
Practice Address - Fax:303-457-9859
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97971Medicare UPIN