Provider Demographics
NPI:1861456618
Name:BONANNI, JULIE ANN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE ANN
Middle Name:M
Last Name:BONANNI
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 1:1365 NEW SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-7213
Mailing Address - Country:US
Mailing Address - Phone:518-439-7600
Mailing Address - Fax:
Practice Address - Street 1:1365 NEW SCOTLAND RD
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-7213
Practice Address - Country:US
Practice Address - Phone:518-439-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005292-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY530615Medicare ID - Type Unspecified
U28459Medicare UPIN