Individual
FRED S BODKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7504 ANTIOCH RD, OVERLAND PARK, KS 66204-2622
(913) 341-3100
(913) 341-6818
Mailing address
PO BOX 803861, KANSAS CITY, MO 64180-3861
(913) 341-3100
(913) 341-6818
Taxonomy
Speciality
Code
Description
License number
State
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
04-25774
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180022395
RAILROAD MEDICARE
—
Enumeration date
10/05/2005
Last updated
02/03/2025
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