Individual
DR. RONALD DUSTIN BODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
586 5TH ST, SUITE 300, BROOKINGS, OR 97415-9720
(541) 469-7775
(541) 469-3102
Mailing address
586 5TH ST, SUITE 300, BROOKINGS, OR 97415-9720
(541) 469-7775
(541) 469-3102
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2988T
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027977
—
OR
Enumeration date
08/31/2006
Last updated
07/08/2007
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