MEDICARE: DR. JULIE ANN M BONANNI 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	VUT005292-1	NY

General Provider Information

NPI Number	:	1861456618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE ANN M BONANNI OD

Provider Business Mailing Address
First Line	:	1365 NEW SCOTLAND RD
Second Line	:
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-7213
Country	:	US
Telephone Number	:	518-439-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 NEW SCOTLAND RD
Second Line	:
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-7213
Country	:	US
Telephone Number	:	518-439-7600
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	03/04/2021

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