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General NPI Number Information
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NPI Number | 1275908642
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Entity Type | Organization
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Legal Business Name | BONAVISTA OPTICS INC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 3900 W ALAMEDA AVE SUITE 1200
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City | BURBANK
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State | CA
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Zip | 91505-4316
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Country | US
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Telephone | 424-404-5415
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 W ALAMEDA AVE SUITE 1200
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City | BURBANK
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State | CA
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Zip | 91505-4316
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Country | US
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Telephone | 424-404-5415
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, OPTICIAN
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Name | MRS. BONNIE J ASHLEY
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Credential | LABOC, NCLEC
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Telephone | 424-202-5415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | SL40477
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | CL8116
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CL8116
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | SL40477
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | D70648
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | D70648
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License Number State | CA
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