Individual
DR. MICHAEL G BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
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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