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General NPI Number Information
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NPI Number | 1457356032
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Entity Type | Individual
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Provider Name | MYRON EUGENE BODNAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 970 E WASHINGTON ST STE 201
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City | MEDINA
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State | OH
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Zip | 44256-2171
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Country | US
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Telephone | 330-725-7748
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Fax | 330-722-5552
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Provider Business Mailing Address
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Address Line | 5484 CHAMPION CREEK BLVD
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City | MEDINA
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State | OH
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Zip | 44256-6812
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Country | US
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Telephone | 330-764-4281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 35049330B
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License Number State | OH
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