Mallory Phillips Bodford (NPI# 1932518032, PAC ID# 1658704010) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OPTOMETRY.
| Nation Provider ID (NPI) | 1932518032 |
| PAC ID by PECOS | 1658704010 |
| Professional Enrollment ID | I20191126001158 |
| Full Name | Mallory Phillips Bodford |
| Organization Legal Name | HORN LAKE EYECARE, PLLC |
| Address |
2085 Goodman Rd W Horn Lake MS 38637-1416 |
| Phone Number | 6628933300 |
| Gender | F |
| Medical School | SOUTHERN COLLEGE OF OPTOMETRY |
| Graduation Year | 2014 |
| Primary Specialty | OPTOMETRY |
| Group Practice PAC ID | 4486889284 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 2085 Goodman Rd W, Horn Lake, MS 38637-1416 | 6628933300 | HORN LAKE EYECARE, PLLC |
| Organization Legal Name | HORN LAKE EYECARE, PLLC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Walter Pang | Optometry | Horn Lake Eyecare, Pllc | 2085 Goodman Rd W, Horn Lake, MS 38637-1416 |
| Nicole Y Monroe | Optometry | Horn Lake Eyecare, Pllc | 2085 Goodman Rd W, Horn Lake, MS 38637-1416 |
| Street Address |
2085 GOODMAN RD W |
| City | HORN LAKE |
| State | MS |
| Zip | 38637-1416 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lanissa Odor | Nurse Practitioner | Sandk Medical, LLC | 2085 Goodman Rd W, Superior Health and Wellness, Horn Lake, MS 38637-1416 |
| Diane Ferguson | Family Medicine | Sandk Medical, LLC | 2085 Goodman Rd W, Superior Health and Wellness, Horn Lake, MS 38637-1416 |
| Walter Pang | Optometry | Horn Lake Eyecare, Pllc | 2085 Goodman Rd W, Horn Lake, MS 38637-1416 |
| Nicole Y Monroe | Optometry | Horn Lake Eyecare, Pllc | 2085 Goodman Rd W, Horn Lake, MS 38637-1416 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Achin Sharma | Family Medicine | Horn Lake Family Practice Inc | 3102 Goodman W Rd, Horn Lake, MS 38637-1172 |
| Timothy G Davis | Nurse Practitioner | Horn Lake Family Practice Inc | 3102 Goodman W Rd, Horn Lake, MS 38637-1172 |
| Zelma S Allen | Nurse Practitioner | Horn Lake Family Practice Inc | 3102 Goodman W Rd, Horn Lake, MS 38637-1172 |
| Lindsay Stegall Nixon | Nurse Practitioner | Convenient Care Clinic Pllc | 3040 Goodman W Rd, Horn Lake, MS 38637-1189 |
| Sandra M Newsom | Nurse Practitioner | 2906 Goodman W Rd, Suite 109, Horn Lake, MS 38637-1291 | |
| Sarita J Glover-jackson | Nurse Practitioner | Take Care Health Mississippi PC | 1501 Goodman Rd W, Horn Lake, MS 38637-1400 |
| Lori K Witmer | Nurse Practitioner | Take Care Health Mississippi PC | 1501 Goodman Rd W, Horn Lake, MS 38637-1400 |
| City | HORN LAKE |
| Zip Code | 38637 |
| Specialty | OPTOMETRY |
| City + Specialty | HORN LAKE + OPTOMETRY |
Please comment or provide details below to improve the information on Mallory Phillips Bodford.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.