Individual
DR. JEREMY JAMES BRODERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3539 SOUTHERN HILLS DR, SIOUX CITY, IA 51106-4750
(712) 276-2323
(712) 274-9986
Mailing address
3400 WALDEN AVE, SIOUX CITY, IA 51106-4618
(712) 276-2415
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2181
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1289819
—
IA
Enumeration date
08/31/2006
Last updated
07/08/2007
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