Individual
DR. BRODERICK DEVON MOSES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4500 VETERANS MEMORIAL BLVD., TARGET OPTICAL, METAIRIE, LA 70006-5330
(504) 454-3791
(504) 456-3058
Mailing address
4500 VETERANS MEMORIAL BLVD, TARGET OPTICAL, METAIRIE, LA 70006-5330
(504) 454-3791
(504) 456-3058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1383-519T
LA
152W00000X
Optometrist
6684TG
TX
Other
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
Enumeration date
08/31/2006
Last updated
07/21/2022
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