MEDICARE: BONNIE NG, O.D., A PROFESSIONAL CORPORATION

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	OPT12232T	CA

General Provider Information

NPI Number	:	1841786837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONNIE NG, O.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1544 CHURCH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2018
Country	:	US
Telephone Number	:	415-648-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 CHURCH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2018
Country	:	US
Telephone Number	:	415-648-4200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BONNIE NG
Credential	:	OD
Telephone Number	:	415-648-4200

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	07/03/2018

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