Provider Demographics
NPI:1437223591
Name:NEIL BODERMAN PC
Entity Type:Organization
Organization Name:NEIL BODERMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BODERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-435-9888
Mailing Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4858
Mailing Address - Country:US
Mailing Address - Phone:610-435-9888
Mailing Address - Fax:610-435-7809
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4858
Practice Address - Country:US
Practice Address - Phone:610-435-9888
Practice Address - Fax:610-435-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056018Medicare PIN
PA410047799Medicare PIN
PA4349490001Medicare NSC