Individual
JOHN S BONEBRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
707 N 36TH ST, SUITE A, SAINT JOSEPH, MO 64506-2968
(816) 279-5683
(816) 279-5685
Mailing address
707 N 36TH ST, SUITE A, SAINT JOSEPH, MO 64506-2968
(816) 279-5683
(816) 279-5685
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T02478
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108900
BC BS
—
01
—
200111698
CDS
MO
05
—
311944706
—
MO
01
—
410048243
RR MEDICARE
—
Enumeration date
07/19/2005
Last updated
03/07/2023
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