Healthcare Provider Details

I. General information

NPI: 1306109087
Provider Name (Legal Business Name): ABBEY J BONNELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBEY R JOHNSON OD

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PARK PL
BELLEFONTE PA
16823-2557
US

IV. Provider business mailing address

88 HARDEES DR
MIFFLINBURG PA
17844-7062
US

V. Phone/Fax

Practice location:
  • Phone: 866-995-3937
  • Fax:
Mailing address:
  • Phone: 570-966-5582
  • Fax: 570-966-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002621
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: