Healthcare Provider Details

I. General information

NPI: 1588514194
Provider Name (Legal Business Name): ALEXIS BONENFANT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 EASTERN AVE
AUGUSTA ME
04330-5900
US

IV. Provider business mailing address

227 EASTERN AVE
AUGUSTA ME
04330-5900
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-3185
  • Fax: 207-622-5697
Mailing address:
  • Phone: 207-622-3185
  • Fax: 207-622-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT1121
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: