Individual
ALISSA BRODER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3803 BROADWAY, ASTORIA, NY 11103-3183
(718) 956-3000
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 233-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
009627
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2022
Last updated
08/05/2022
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