Healthcare Provider Details

I. General information

NPI: 1932100997
Provider Name (Legal Business Name): BONNIE S ELDREDGE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MIDDLETOWN BLVD SUITE 102
LANGHORNE PA
19047-3200
US

IV. Provider business mailing address

170 MIDDLETOWN BLVD STE 102
LANGHORNE PA
19047-3200
US

V. Phone/Fax

Practice location:
  • Phone: 215-891-9165
  • Fax: 215-891-9836
Mailing address:
  • Phone: 215-891-9165
  • Fax: 215-891-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: