Provider Demographics
NPI:1407040033
Name:FRANK, BONNIE L (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:FRANK
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BROADWAY ST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-2768
Mailing Address - Country:US
Mailing Address - Phone:970-522-5294
Mailing Address - Fax:970-522-5294
Practice Address - Street 1:100 BROADWAY ST
Practice Address - Street 2:SUITE 26
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2768
Practice Address - Country:US
Practice Address - Phone:970-522-5294
Practice Address - Fax:970-522-5294
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
NOT APPLICABLE156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1179380001Medicare PIN