Provider Demographics
NPI:1902652175
Name:BRODIE, CHELSIA
Entity type:Individual
Prefix:
First Name:CHELSIA
Middle Name:
Last Name:BRODIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 PEPPERTREE TER
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6129
Mailing Address - Country:US
Mailing Address - Phone:850-797-1392
Mailing Address - Fax:
Practice Address - Street 1:2650 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7382
Practice Address - Country:US
Practice Address - Phone:850-479-1422
Practice Address - Fax:850-479-1419
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7584156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician