MEDICARE: DR. KATHRYN H BONY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	002228	CT

General Provider Information

NPI Number	:	1013997923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN H BONY OD

Provider Business Mailing Address
First Line	:	79 WAWECUS ST
Second Line	:	SUITE 105
City	:	NORWICH
State	:	CT
Zip	:	06360-2160
Country	:	US
Telephone Number	:	860-886-0161
Fax Number	:	860-889-5999

Provider Business Practice Location Address
First Line	:	79 WAWECUS ST
Second Line	:	SUITE 105
City	:	NORWICH
State	:	CT
Zip	:	06360-2160
Country	:	US
Telephone Number	:	860-886-0161
Fax Number	:	860-889-5999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	06/14/2011

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