Provider Demographics
NPI:1588749444
Name:BRODTMANN, RICHARD HILAIRE (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HILAIRE
Last Name:BRODTMANN
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 1:101 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:830-629-6221
Mailing Address - Fax:830-629-3028
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:830-629-6221
Practice Address - Fax:830-629-3028
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2507T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT91715Medicare UPIN
TX00E42JMedicare ID - Type UnspecifiedMEDICARE