Marc G Bodman, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD.201176 Issued in LA

Practice address

12731 New Brittany Blvd
Fort Myers, FL 33907-3632

Phone

(239) 418-0999

Fax

(239) 418-0091

NPI assigned

Jul 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275868800000",
    "number": "1376742957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61199",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339061199",
            "telephone_number": "239-418-0999",
            "fax_number": "239-418-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12731 NEW BRITTANY BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073632",
            "telephone_number": "239-418-0999",
            "fax_number": "239-418-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODMAN",
        "first_name": "MARC",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2010-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "046489",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "LA",
            "license": "MD.201176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00601031",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508098",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Veronica Bocharova, PT, DPT
• Parker Joseph Boches, DDS
• Brian Lee Bochette, P.T.
• Brian Christopher Bockelman, M.D.
• Aditya Reddy Boddu
• Joseph Boe
• Marissa Leigh Boe, PA-C
• Shannon Boe
• Kaitlyn Boesenberg
• Charles Christopher Boggs, M.D.

• Ophthalmology Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2010; 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.