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General NPI Number Information
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NPI Number | 1295921096
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Entity Type | Organization
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Legal Business Name | COLUMBIA EYE ASSOCIATES PA
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Dates
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Enumeration Date | 09/15/2007
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 1615 SW MAIN BLVD
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City | LAKE CITY
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State | FL
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Zip | 32025-1108
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Country | US
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Telephone | 386-755-2785
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Fax | 386-755-1128
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | LAKE CITY
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State | FL
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Zip | 32056-0489
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Country | US
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Telephone | 386-755-2785
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Fax | 386-755-1128
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Authorized Official
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Title or Position | OWNER
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Name | DR. KARL BODENDORFER
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Credential | MD
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Telephone | 386-755-2785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME78478
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License Number State | FL
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