Provider Demographics
NPI:1962841981
Name:BONK, ALEX (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BONK
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 1:702 S FOOTHILLS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-2300
Mailing Address - Country:US
Mailing Address - Phone:865-982-6761
Mailing Address - Fax:
Practice Address - Street 1:702 S FOOTHILLS PLAZA DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-2300
Practice Address - Country:US
Practice Address - Phone:865-982-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3368152W00000X
IL046010662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist