Provider Demographics
NPI:1447248349
Name:BRODNEY, ALAN C (OD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:C
Last Name:BRODNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10390 SANTA MONICA BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5091
Mailing Address - Country:US
Mailing Address - Phone:310-277-2020
Mailing Address - Fax:310-553-9418
Practice Address - Street 1:10390 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5058
Practice Address - Country:US
Practice Address - Phone:310-277-2020
Practice Address - Fax:310-553-9418
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WOP8931AMedicare ID - Type Unspecified
U24889Medicare UPIN