Individual
DAVID R. BONIFACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
329 W 2ND ST, CALEXICO, CA 92231-2114
(760) 357-2712
(760) 357-5710
Mailing address
329 W 2ND ST, CALEXICO, CA 92231-2114
(760) 357-2712
(760) 357-5710
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6874T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0068740
—
CA
Enumeration date
08/21/2006
Last updated
07/09/2007
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