Individual
DR. GARY BODOFSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2014 HIGHWAY 17 N, SURFSIDE BEACH, SC 29575-6072
(843) 238-2020
(843) 238-4443
Mailing address
2014 HIGHWAY 17 N, SURFSIDE BEACH, SC 29575-6072
(843) 238-2020
(843) 238-4443
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
764
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
571062888
UNITED HEALTH CARE
SC
05
—
D00764
—
SC
01
—
SC07890281
MEDICARE PTAN
SC
Enumeration date
03/14/2006
Last updated
11/05/2015
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