Provider Demographics
NPI:1649786112
Name:BOHNE, FREDERICK GERALD (LDO)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:GERALD
Last Name:BOHNE
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 REIDS GRV
Mailing Address - Street 2:
Mailing Address - City:W HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9653
Mailing Address - Country:US
Mailing Address - Phone:585-243-4004
Mailing Address - Fax:585-243-4009
Practice Address - Street 1:24 REIDS GRV
Practice Address - Street 2:
Practice Address - City:W HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9653
Practice Address - Country:US
Practice Address - Phone:585-243-4004
Practice Address - Fax:585-243-4009
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCOO8464-1156FX1800X
NYC008464-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician