Individual
DR. CRAIG A. BONHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1240 MEDICAL PARK DR, FORT WAYNE, IN 46825-5828
(260) 471-2375
(260) 484-3367
Mailing address
PO BOX 549, WABASH, IN 46992-0549
(260) 471-2375
(260) 484-3367
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003136A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200337500
—
IN
Enumeration date
04/05/2006
Last updated
10/14/2014
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