Individual
BONITA BANH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7108 CAMP BOWIE BLVD, FORT WORTH, TX 76116-7198
(817) 738-3191
(817) 738-7724
Mailing address
7108 CAMP BOWIE BLVD, FORT WORTH, TX 76116-7198
(817) 738-3191
(817) 738-7724
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9829T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9829T
TEXAS OPTOMETRY BOARD
TX
Enumeration date
02/03/2020
Last updated
02/03/2020
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