Medro Joseph Brodeur III, O.D., P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TO2435 Issued in MO

Legal business name

MEDRO JOSEPH BRODEUR III, O.D., P.C.

Practice address

356 S Main St
Gerald, MO 63037-2270

Phone

(573) 764-2177

NPI assigned

Oct 20, 2010

Last updated

Oct 20, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Medro Joseph Brodeur III, O.D

Title

Owner

Phone

(573) 764-2177

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1013227370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "356 S MAIN ST",
            "address_2": "BOX 81",
            "city": "GERALD",
            "state": "MO",
            "postal_code": "630372270",
            "telephone_number": "573-764-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "356 S MAIN ST",
            "city": "GERALD",
            "state": "MO",
            "postal_code": "630372270",
            "telephone_number": "573-764-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDRO JOSEPH BRODEUR III, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "BRODEUR",
        "authorized_official_first_name": "MEDRO",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-764-2177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Arthur Groenke, DMD
• Ethan Joers
• Medley Pharmacy Inc (LTC Medley Pharmacy)
• Medley Pharmacy Inc (Medley Pharmacy)
• Medley Pharmacy Inc. (Medley Pharmacy)
• N & R of Gerald, Inc. (Gerald Nursing & Rehab)
• Beth Anne Obermark, M.S.
• Pataky Care Partners
• Janelle Marie Rasmussen, PTA
• Caroline Regan, LCSW

• Optometrist in Gerald, MO
• Providers in Gerald, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.