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Contact Information

MALLORY P BODFORD, OD
6947 CRUMPLER BLVD
OLIVE BRANCH, MS38654-1922
 Phone: 662-893-3300
 Fax: 662-893-3301
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for MALLORY P BODFORD · (Female)

NPI # 1932518032
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 08/04/2014
Last updated 02/17/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • TX License # 8517T
  • MS Medicaid 05005854
  • MS Other 966P-Y MISSISSIPPI STATE LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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