Provider Demographics
NPI:1194704908
Name:SAGER, BONNIE (OD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:SAGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SALEM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3015
Mailing Address - Country:US
Mailing Address - Phone:631-423-3215
Mailing Address - Fax:
Practice Address - Street 1:13 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2405
Practice Address - Country:US
Practice Address - Phone:516-922-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003688152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00494826Medicaid
NY00494826Medicaid
NYC42602Medicare PIN