Provider Demographics
NPI:1306109087
Name:BONNELL, ABBEY J (OD)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:J
Last Name:BONNELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:88 HARDEES DR
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-7062
Mailing Address - Country:US
Mailing Address - Phone:570-966-5582
Mailing Address - Fax:570-966-5586
Practice Address - Street 1:205 PARK PL
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-2557
Practice Address - Country:US
Practice Address - Phone:866-995-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102768606-0003Medicaid