Individual
DR. MICHAEL G BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
435 RIVER AVE, WILLIAMSPORT, PA 17701-3722
(570) 326-8070
(570) 326-0396
Mailing address
137 JPM RD, LEWISBURG, PA 17837-9313
(570) 523-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000810
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012670710001
—
PA
01
—
2027189
BLUE SHIELD
—
01
—
50099291
CAPITAL BLUE CROSS
—
01
—
P00943504
RAILROAD MEDICARE
PA
Enumeration date
07/11/2006
Last updated
01/07/2021
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