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General NPI Number Information
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NPI Number | 1215297619
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Entity Type | Individual
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Provider Name | JENNIFER DANIELLE BOND O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 77 WAINWRIGHT DR WAINWRIGHT MEMORIAL VA MEDICAL CENTER EYE CLINIC 123
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City | WALLA WALLA
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State | WA
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Zip | 99362-3975
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Country | US
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Telephone | 509-527-3491
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Fax | 509-526-6202
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Provider Business Mailing Address
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Address Line | 132 SPRINGDALE RD
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City | WALLA WALLA
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State | WA
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Zip | 99362-7169
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD60290961
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License Number State | WA
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