Provider Demographics
NPI:1245476068
Name:BROGDEN, PAMELA DENISE (OD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:BROGDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-955-6470
Practice Address - Street 1:1253 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2684
Practice Address - Country:US
Practice Address - Phone:410-727-4746
Practice Address - Fax:410-727-6767
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2023-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDTA2129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0383538-00Medicaid