Medro Joseph Brodeur III, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

T02435 Issued in MO

Practice address

531 E Washington Ave
Owensville, MO 65066-1410

Phone

(573) 437-8004

Fax

(573) 437-8004

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470268800000",
    "number": "1821068487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 E WASHINGTON AVE",
            "city": "OWENSVILLE",
            "state": "MO",
            "postal_code": "650661410",
            "telephone_number": "573-437-8004",
            "fax_number": "573-437-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 E WASHINGTON AVE",
            "city": "OWENSVILLE",
            "state": "MO",
            "postal_code": "650661410",
            "telephone_number": "573-437-8004",
            "fax_number": "573-437-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODEUR",
        "first_name": "MEDRO",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2016-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311695118",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madeline Grace Borgerding
• Payton Grace Boyd
• Renee Brandon, LPC
• Bethany D Breeden Smith, LCSW
• Brandylyn S Bristow, LCSW
• Wayne Karlton Brown, L.P.C.
• Elizabeth Ann Bruemmer, MSW, LCSW
• Mary Brune, CCC-SLP
• Stacy Lynn Caldwell, RPH
• Capital Region Medical Center

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2016; 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.