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Individual
DR. GREGORY TAYLOR BODRIE
Active
Individual
DR. GREGORY TAYLOR BODRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
OD 2646 TPA
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0332003
—
MA
01
—
710362
TUFTS HEALTH CARE HMO
MD
01
—
79402030
DET EMPLOYER ID
MA
01
—
W15268
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/30/2006
Last updated
01/11/2010
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