MEDICARE: BODIFORD EYE INSTITUTE, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MC-1402	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	180029680	OTHER	OK	RR MEDICARE
5	180034141	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5B988	OTHER	AR	BLUE CROSS
2	1163920001	OTHER	AR	DMERC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	432291569-001	OTHER	OK	BLUE CROSS

General Provider Information

NPI Number	:	1336219773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODIFORD EYE INSTITUTE, PA

Provider Business Mailing Address
First Line	:	9001 JENNY LIND RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8629
Country	:	US
Telephone Number	:	479-649-7018
Fax Number	:	479-649-7024

Provider Business Practice Location Address
First Line	:	9001 JENNY LIND RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8629
Country	:	US
Telephone Number	:	479-649-7018
Fax Number	:	479-649-7024

Authorized Official
Title or Position	:	OWNER
Name	:	GARY L BODIFORD
Credential	:	M.D.
Telephone Number	:	479-649-7018

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	04/01/2013

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Directions to “BODIFORD EYE INSTITUTE, PA ” Practice Location

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