Healthcare Provider Details

I. General information

NPI: 1750358404
Provider Name (Legal Business Name): BONNY L. EADS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 10TH ST N
NAPLES FL
34102-6217
US

IV. Provider business mailing address

60 10TH ST N
NAPLES FL
34102-6217
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-7071
  • Fax: 239-263-0807
Mailing address:
  • Phone: 239-261-7071
  • Fax: 239-263-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: