Organization
BONAVISTA OPTICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BONNIE J ASHLEY LABOC, NCLEC (PRESIDENT, OPTICIAN)
(424) 202-5415
Entity
Organization
Contact information
Practice address
3900 W ALAMEDA AVE, SUITE 1200, BURBANK, CA 91505-4316
(424) 404-5415
Mailing address
3900 W ALAMEDA AVE, SUITE 1200, BURBANK, CA 91505-4316
(424) 404-5415
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
CL8116
CA
332H00000X
Eyewear Supplier
D70648
CA
332H00000X
Eyewear Supplier
SL40477
CA
335E00000X
Prosthetic/Orthotic Supplier
CL8116
CA
335E00000X
Prosthetic/Orthotic Supplier
Primary
D70648
CA
335E00000X
Prosthetic/Orthotic Supplier
SL40477
CA
Other
Enumeration date
12/10/2015
Last updated
05/01/2017
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