Provider Demographics
NPI:1780845826
Name:OLYMPIA EYE CLINIC PLLC
Entity Type:Organization
Organization Name:OLYMPIA EYE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BODOIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-456-4800
Mailing Address - Street 1:215 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5030
Mailing Address - Country:US
Mailing Address - Phone:360-456-4800
Mailing Address - Fax:
Practice Address - Street 1:724 COLUMBIA ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1291
Practice Address - Country:US
Practice Address - Phone:360-456-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical