Provider Demographics
NPI:1194789727
Name:AIKEN, BONNIE E (OD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:E
Last Name:AIKEN
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 1:2120 STATESVILLE BLVD.
Mailing Address - Street 2:EYECARE CENTER
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147
Mailing Address - Country:US
Mailing Address - Phone:704-636-0559
Mailing Address - Fax:704-636-6627
Practice Address - Street 1:2120 STATESVILLE BLVD
Practice Address - Street 2:EYECARE CENTER
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1410
Practice Address - Country:US
Practice Address - Phone:704-636-0559
Practice Address - Fax:704-636-6627
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0944842OtherOPICARE
NC890904KMedicaid
NC2468501COtherMEDICARE ID
NC0912XOtherBCBS OF NC
NC2472021OtherSECOND PTAN
NC410046981OtherRAILROAD MEDICARE
NC296143OtherMAMSI
NC410046981OtherRAILROAD MEDICARE
NC296143OtherMAMSI
NC2468501COtherMEDICARE ID