Provider Demographics
NPI:1457356032
Name:BODNAR, MYRON EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:EUGENE
Last Name:BODNAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5484 CHAMPION CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-6812
Mailing Address - Country:US
Mailing Address - Phone:330-764-4281
Mailing Address - Fax:
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:STE 201
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2171
Practice Address - Country:US
Practice Address - Phone:330-725-7748
Practice Address - Fax:330-722-5552
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049330B207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721955Medicaid
OH0721955Medicaid
OH0613098Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER