Provider Demographics
NPI:1598866881
Name:BONNIN, GARY GILBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:GILBERT
Last Name:BONNIN
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 1:23032 N 22ND WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-9515
Mailing Address - Country:US
Mailing Address - Phone:480-247-6224
Mailing Address - Fax:
Practice Address - Street 1:1646 W MONTEBELLO AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2557
Practice Address - Country:US
Practice Address - Phone:602-242-1105
Practice Address - Fax:602-293-4534
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ605152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist