Individual
BONNIE CHRISTINE KOVACS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
555 E BROADWAY AVE STE 214, JACKSON, WY 83001-8640
(307) 733-1051
Mailing address
PO BOX 30015 DPT 93, SALT LAKE CITY, UT 84130-0015
(307) 733-1051
(307) 733-0686
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
243T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120435100
—
WY
01
—
5340400001
MEDICARE DMEPOS
WY
Enumeration date
11/15/2006
Last updated
08/21/2019
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