Provider Demographics
NPI:1245497502
Name:DR. ALBERT D. BOHON, JR., OPTOMETRIST
Entity type:Organization
Organization Name:DR. ALBERT D. BOHON, JR., OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOHON
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:757-547-2777
Mailing Address - Street 1:311 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5309
Mailing Address - Country:US
Mailing Address - Phone:757-547-2777
Mailing Address - Fax:757-436-5217
Practice Address - Street 1:311 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5309
Practice Address - Country:US
Practice Address - Phone:757-547-2777
Practice Address - Fax:757-436-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU57032Medicare UPIN
VA0894530001Medicare NSC