Individual
DR. GREGORY TAYLOR BODRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
66 PLEASANT ST., SAGAMORE, MA 02561-0532
(508) 888-2020
(508) 888-4423
Mailing address
PO BOX 532, 66 PLEASANT ST, SAGAMORE, MA 02561-0532
(508) 888-2020
(508) 888-4423
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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