Provider Demographics
NPI:1750309597
Name:BONNER, WILLIAM C (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:BONNER
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 1:9875 MEDLOCK BRIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6640
Mailing Address - Country:US
Mailing Address - Phone:770-813-0026
Mailing Address - Fax:770-813-0029
Practice Address - Street 1:1034 HAW CREEK CIR STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6513
Practice Address - Country:US
Practice Address - Phone:678-737-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT41414Medicare UPIN