Provider Demographics
NPI:1841259470
Name:BONO, KATIE MARISA (OD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MARISA
Last Name:BONO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:MARISA
Other - Last Name:HOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2921 ERIE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:4551 COMMERCIAL DRIVE
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-768-1000
Practice Address - Fax:315-768-1004
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0068061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB4173Medicare PIN
NYRA4172Medicare ID - Type Unspecified
V01084Medicare UPIN