Individual
VIRGINIA BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
70 E 68TH PL, MERRILLVILLE, IN 46410-3506
(219) 736-2020
Mailing address
70 E 68TH PL, MERRILLVILLE, IN 46410-3506
(219) 736-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003773A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201148230
—
IN
Enumeration date
04/05/2013
Last updated
05/07/2015
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