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General NPI Number Information
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NPI Number | 1457287401
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Entity Type | Individual
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Provider Name | MAXWELL BONGHI O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 4389 BEAUFORT RD, HAVELOCK, NC
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City | FPO
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State | AA
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Zip | 28532
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Country | US
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Telephone | 252-466-0921
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Fax |
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Provider Business Mailing Address
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Address Line | 213 LYNDEN LN
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City | NEW BERN
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State | NC
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Zip | 28560-8556
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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 | 14289376-9934
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License Number State | UT
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