Individual
NILAH NICOLE BONHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
325 W NATIONAL AVENUE, BRAZIL, IN 47834
(812) 443-0060
(812) 446-5061
Mailing address
325 W NATIONAL AVENUE, BRAZIL, IN 47834
(812) 443-0060
(812) 446-5061
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003365A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18003365A
LICENSE
IN
01
—
18003365B
INDIANA OLDPAC LIC.
IN
01
—
254870
PTAN
IN
Enumeration date
09/05/2006
Last updated
07/22/2014
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