Provider Demographics
NPI:1336304070
Name:JAMES BOHDAN OD & ASSOCIATES PC
Entity Type:Organization
Organization Name:JAMES BOHDAN OD & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOHDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-981-5820
Mailing Address - Street 1:42461 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3303
Mailing Address - Country:US
Mailing Address - Phone:734-981-5820
Mailing Address - Fax:734-981-7577
Practice Address - Street 1:42461 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3303
Practice Address - Country:US
Practice Address - Phone:734-981-5820
Practice Address - Fax:734-981-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI2602261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M96220Medicare PIN
MI0767620001Medicare NSC