Provider Demographics
NPI:1992112197
Name:BODWELL, JOY (OD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BODWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:ZUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 LILLY RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5118
Mailing Address - Country:US
Mailing Address - Phone:360-491-2121
Mailing Address - Fax:
Practice Address - Street 1:406 LILLY RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5118
Practice Address - Country:US
Practice Address - Phone:360-491-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60587417152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist