Provider Demographics
NPI:1982955571
Name:DANIEL BRODKEY OD PC
Entity Type:Organization
Organization Name:DANIEL BRODKEY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BRODKEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-274-2020
Mailing Address - Street 1:5404 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3136
Mailing Address - Country:US
Mailing Address - Phone:712-274-2020
Mailing Address - Fax:712-274-7095
Practice Address - Street 1:5404 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3136
Practice Address - Country:US
Practice Address - Phone:712-274-2020
Practice Address - Fax:712-274-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty