Individual
DR. BRUCE IRA BODNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
241 CORPORATE BLVD, NORFOLK, VA 23502-4954
(757) 622-2200
Mailing address
400 GRESHAM DR, SUITE 403, NORFOLK, VA 23507-1901
(757) 622-2200
(757) 622-4866
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101021043
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
332516
PIN/BCBS
VA
05
—
6384021
—
VA
Enumeration date
07/18/2005
Last updated
07/08/2007
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