Provider Demographics
NPI:1861681678
Name:CHEN, BONNIE PAN (OD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:PAN
Last Name:CHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8415 PIT STOP COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8186
Mailing Address - Country:US
Mailing Address - Phone:704-979-3937
Mailing Address - Fax:888-809-1433
Practice Address - Street 1:8415 PIT STOP COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8186
Practice Address - Country:US
Practice Address - Phone:704-979-3937
Practice Address - Fax:888-809-1433
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 1929152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist