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General NPI Number Information
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NPI Number | 1730814336
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Entity Type | Individual
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Provider Name | MARIA BONTRAGER OD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1320 HWY 290 E
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City | ELGIN
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State | TX
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Zip | 78621-1400
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Country | US
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Telephone | 512-229-5911
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Fax | 512-677-6282
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Provider Business Mailing Address
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Address Line | 1320 HWY 290 E
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City | ELGIN
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State | TX
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Zip | 78621-1400
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Country | US
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Telephone | 512-229-5911
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Fax | 512-677-6282
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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 | 10528T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2362
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License Number State | SC
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