Individual provider Active NPI

Michelle A. Broderick, O.D.

  • Optometrist
  • Brunswick, ME
National Provider Identifier
1003814096
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT767 Issued in ME
Practice address
82 Maine St
Brunswick, ME 04011-2015
Phone
(207) 729-8474
Fax
(207) 729-8955
NPI assigned
Jul 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT767 ME Primary

Addresses

Primary practice location

82 Maine St
Brunswick, ME 04011-2015

Mailing address

82 Maine St
Brunswick, ME 04011-2015
Phone (207) 729-8474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050614001176 ME Practitioner - Optometry 7911941570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maine Optometry PAGroup PAC ID 8022009117, 23 clinicians

Practice addresses (Care Compare)

14 Vista Dr
Suite 200
Gorham, ME 04038-5884
Phone (207) 729-8474

656 Roosevelt TRL
Windham, ME 04062-5271
Phone (207) 729-8474

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT767MEMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Maine Optometry PA Optometrist CurrentSince Aug 17, 1990 Accepting new patients
Roger L. Bergeron, O.D.P.a. Past Accepting new patients

Locations

242 Bath Rd
Brunswick, ME 04011
Phone (207) 389-3525

82 Maine St
Brunswick, ME 04011

407 US Route 1
Freeport, ME 04032
Phone (207) 865-2023

14 Vista Dr
Ste 200
Gorham, ME 04038

347 Main St
Ste D
Gorham, ME 04038
Phone (207) 839-2638

585 Main St
Lewiston, ME 04240
Phone (207) 784-0153

Interoperability endpoints

  • Direct secure messaging: michellebroderick@maineoptometry.eyefinity-direct.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1003814096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 MAINE ST",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112015",
            "telephone_number": "207-729-8474",
            "fax_number": "207-729-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 MAINE ST",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112015",
            "telephone_number": "207-729-8474",
            "fax_number": "207-729-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "MICHELLE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-13",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, ME

Sources for this page

Verify at the official NPI Registry.