Provider Demographics
NPI:1114968245
Name:PENG, BONNIE CHOW (OD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:CHOW
Last Name:PENG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-1938
Mailing Address - Country:US
Mailing Address - Phone:626-358-1080
Mailing Address - Fax:626-305-9150
Practice Address - Street 1:855 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-1938
Practice Address - Country:US
Practice Address - Phone:626-358-1080
Practice Address - Fax:626-305-9150
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11943T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11943AMedicare ID - Type Unspecified
CAU94703Medicare UPIN