Healthcare Provider Details

I. General information

NPI: 1740661347
Provider Name (Legal Business Name): BONNIE J ASHLEY LABOC, NCLEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 RUNNYMEDE RD
OAKWOOD OH
45419-3322
US

IV. Provider business mailing address

610 RUNNYMEDE RD
OAKWOOD OH
45419-3322
US

V. Phone/Fax

Practice location:
  • Phone: 937-250-1810
  • Fax: 937-250-1812
Mailing address:
  • Phone: 937-250-1810
  • Fax: 937-250-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License NumberDIO-434
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberOP.017041-SC
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDIO-434
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.017041-SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: