# DR. BRODERICK DEVON MOSES

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1245342898
- **Gender:** Man
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 1383-519T | LA | Yes |
| 152W00000X | Optometrist | 6684TG | TX | — |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1245342898 | BLUE CROSS BLUE SHIELD OF TEXAS: INDIVIDUAL | TX |
| 01 | — | 1417146994 | BLUE CROSS BLUE SHIELD OF TEXAS: GROUP | TX |
| 05 | — | 1627348 | — | LA |
| 01 | — | 82393Q | BLUE CROSS BLUE SHIELD OF TEXAS | TX |