Marie I. Bodack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3150 Issued in TN

Practice address

1225 Madison Ave
Memphis, TN 38104-2211

Phone

(901) 722-3250

Fax

(901) 722-3347

NPI assigned

Mar 14, 2006

Last updated

Nov 26, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

State University of New York - State College Optometry, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern College of OptometryGroup PAC ID 4587550454, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern College of Optometry

  • Optometrist
  • Memphis, TN
  • NPI 1851384986
  Medicare reassignment Care Compare group NPD
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385424000000",
    "number": "1356310353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042211",
            "telephone_number": "901-722-3250",
            "fax_number": "901-722-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042211",
            "telephone_number": "901-722-3250",
            "fax_number": "901-722-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODACK",
        "first_name": "MARIE",
        "middle_name": "I.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2013-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.5605-THER",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexa Valeria Bobelis, ARNP
• Anne Margaret Boberski
• Lyndon Mark Bobinger, DPH
• Jay Allison Bobo
• Larisa Anatolievna Bobr
• Lashawnda Del Boddie, P.T.
• Erin Marie Bodenbach
• John William Bodford Jr., M.D.
• Bodied by Flossy Inc
• Body Mechanix, LLC Therapeutic Massage

• Optometrist in Memphis, TN
• Providers in Memphis, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.