Individual
ROBERT M. BROADDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
13839 S MUR LEN RD STE A, OLATHE, KS 66062-1661
(913) 782-5993
Mailing address
13839 S MUR LEN RD STE A, OLATHE, KS 66062-1661
(913) 782-5993
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1591
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1591
STATE LICENSE
KS
01
—
30592028
BLUE CROSS BLUE SHIELD
MO
Enumeration date
12/06/2006
Last updated
07/08/2007
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