# B. RATANAWONGSA, MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285769000
- **Authorized official:** BOONLUA RATANAWONGSA MD (PRESIDENT)
- **Authorized official phone:** (716) 373-0444

## Contact information

- **Practice address:** 2223 W STATE ST, SUITE 107, OLEAN, NY 14760-1938
- **Practice address phone:** (716) 373-0444
- **Practice address fax:** (716) 373-5031
- **Mailing address:** 5 CIRCLE OAK DR, ALLEGANY, NY 14706-1101
- **Mailing address phone:** (716) 373-0444
- **Mailing address fax:** (716) 373-5031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 118639-1 | NY | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00590010 | — | NY |