Provider Demographics
NPI:1518196914
Name:BONDS, DESARAE (OD)
Entity Type:Individual
Prefix:DR
First Name:DESARAE
Middle Name:
Last Name:BONDS
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 1:600 GARSON DR NE APT 10307
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-6215
Mailing Address - Country:US
Mailing Address - Phone:678-770-9941
Mailing Address - Fax:404-303-6628
Practice Address - Street 1:6631 ROSWELL RD STE G
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3179
Practice Address - Country:US
Practice Address - Phone:404-843-8248
Practice Address - Fax:404-303-6628
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist