Provider Demographics
NPI:1740661347
Name:ASHLEY, BONNIE J (LABOC, NCLEC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:J
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:LABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 RUNNYMEDE RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3322
Mailing Address - Country:US
Mailing Address - Phone:937-250-1810
Mailing Address - Fax:937-250-1812
Practice Address - Street 1:610 RUNNYMEDE RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-3322
Practice Address - Country:US
Practice Address - Phone:937-250-1810
Practice Address - Fax:937-250-1812
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-434156FC0800X, 156FX1800X, 156FX1800X
OHOP.017041-SC156FC0801X, 156FX1800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter