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Organization
B. RATANAWONGSA, MD, PC
Active
Organization
B. RATANAWONGSA, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOONLUA RATANAWONGSA MD (PRESIDENT)
(716) 373-0444
Entity
Organization
Contact information
Practice address
2223 W STATE ST, SUITE 107, OLEAN, NY 14760-1938
(716) 373-0444
(716) 373-5031
Mailing address
5 CIRCLE OAK DR, ALLEGANY, NY 14706-1101
(716) 373-0444
(716) 373-5031
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
118639-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00590010
—
NY
Enumeration date
02/22/2007
Last updated
08/22/2020
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