Individual
JEANETTE BONSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-9441
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0874
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
547658500
—
MD
Enumeration date
01/13/2006
Last updated
08/15/2022
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