Healthcare Provider Details

I. General information

NPI: 1598813750
Provider Name (Legal Business Name): BORIS OVODENKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 IMMOKALEE RD # 203
NAPLES FL
34110-1445
US

IV. Provider business mailing address

2338 IMMOKALEE RD # 203
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 239-359-6259
  • Fax: 239-919-4342
Mailing address:
  • Phone: 239-359-6259
  • Fax: 239-919-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number235346
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number076640
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME103168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: