Provider Demographics
NPI:1235394230
Name:BOHONOS, MELISSA AJUNWA (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:AJUNWA
Last Name:BOHONOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:OBIAGELI
Other - Last Name:AJUNWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16111 SAN PEDRO AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3063
Mailing Address - Country:US
Mailing Address - Phone:210-729-0544
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:16111 SAN PEDRO AVE STE 123
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3063
Practice Address - Country:US
Practice Address - Phone:210-729-0544
Practice Address - Fax:210-729-0545
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7013207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400093346Medicare PIN