MEDICARE: DR. BRYON A BOHNET OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002433	MI

General Provider Information

NPI Number	:	1306847421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYON A BOHNET OD

Provider Business Mailing Address
First Line	:	125 W CEDAR ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5251
Country	:	US
Telephone Number	:	269-381-3937
Fax Number	:	269-381-3977

Provider Business Practice Location Address
First Line	:	125 W CEDAR ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5251
Country	:	US
Telephone Number	:	269-381-3937
Fax Number	:	269-381-3977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	12/26/2007

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