Organization
DANIEL J BROZA, O.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL BROZA O.D. (OPTOMETRIST)
(757) 345-0975
Entity
Organization
Contact information
Practice address
12121 JEFFERSON AVE, NEWPORT NEWS, VA 23602-6916
(757) 746-2014
(757) 746-2046
Mailing address
5312 FOUNDATION ST, WILLIAMSBURG, VA 23188-2867
(757) 345-0975
(757) 746-2046
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
0618000779
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00X764T01
MEDICARE PTAN
VA
Enumeration date
01/21/2015
Last updated
01/21/2015
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