Ted Borodofsky, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

18831 Issued in KY

Practice address

1903 Broadway St
Paducah, KY 42001-7105

Phone

(270) 442-1671

Fax

(270) 442-7307

NPI assigned

Mar 2, 2006

Last updated

Oct 25, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193270400000",
    "number": "1013984624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 BROADWAY ST",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017105",
            "telephone_number": "270-442-1671",
            "fax_number": "270-442-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 BROADWAY ST",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017105",
            "telephone_number": "270-442-1671",
            "fax_number": "270-442-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORODOFSKY",
        "first_name": "TED",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2007-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "18831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000044965",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0470669210",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64188311",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marinena Bondurant, R.PH.
• Sherry Bone, LPP
• Whitny J Booher
• Thomas M Boone-Abraham, PHARMD
• Madison Boone, PT, DPT
• Sanjay Bose, MD
• Macey E Boutwell
• Natalie Boward
• Beth Nicole Bowden
• Van A Bowden, RPH

• Ophthalmology Physician in Paducah, KY
• Providers in Paducah, KY by specialty
• Ophthalmology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.