Provider Demographics
NPI:1417996158
Name:GUNTER, BONNIE RAE (OD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:RAE
Last Name:GUNTER
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 1:4208 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1147
Mailing Address - Country:US
Mailing Address - Phone:406-251-4249
Mailing Address - Fax:
Practice Address - Street 1:1429 S HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4251
Practice Address - Country:US
Practice Address - Phone:406-549-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist