Provider Demographics
NPI:1750341186
Name:BONILLA-WARFORD, NATHAN JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JAMES
Last Name:BONILLA-WARFORD
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 1:10108 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1856
Mailing Address - Country:US
Mailing Address - Phone:813-792-0637
Mailing Address - Fax:813-792-0657
Practice Address - Street 1:10108 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1856
Practice Address - Country:US
Practice Address - Phone:813-792-0637
Practice Address - Fax:813-792-0657
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4098152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6623WMedicare PIN