Healthcare Provider Details

I. General information

NPI: 1609130772
Provider Name (Legal Business Name): ZACHARY BODNAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2749 SUNRIDGE HEIGHTS PKWY
HENDERSON NV
89052-5044
US

IV. Provider business mailing address

5295 S DURANGO DR STE 102
LAS VEGAS NV
89113-0188
US

V. Phone/Fax

Practice location:
  • Phone: 702-358-0472
  • Fax: 702-425-9955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number18780
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: