Provider Demographics
NPI:1588669741
Name:OWENS, BONNY LOU (CVBCS)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:LOU
Last Name:OWENS
Suffix:
Gender:F
Credentials:CVBCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1248
Mailing Address - Country:US
Mailing Address - Phone:716-836-4090
Mailing Address - Fax:716-836-4036
Practice Address - Street 1:1405 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14217-1248
Practice Address - Country:US
Practice Address - Phone:716-836-4090
Practice Address - Fax:716-836-4036
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01482631Medicaid
NY000551182001Medicare UPIN
NY8290310Medicare UPIN
NY00011281601Medicare UPIN
NY040401000147Medicare UPIN
NY01482631Medicaid