Provider Demographics
NPI:1306847421
Name:BOHNET, BRYON A (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYON
Middle Name:A
Last Name:BOHNET
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5251
Mailing Address - Country:US
Mailing Address - Phone:269-381-3937
Mailing Address - Fax:269-381-3977
Practice Address - Street 1:125 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5251
Practice Address - Country:US
Practice Address - Phone:269-381-3937
Practice Address - Fax:269-381-3977
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OC96524Medicare ID - Type Unspecified
MI0485220001Medicare NSC
T32974Medicare UPIN