Provider Demographics
NPI:1316998529
Name:CHALKER, BONNIE MARIE (OD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:CHALKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:MARIE
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1240 PALM COAST PKWY SW
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4700
Mailing Address - Country:US
Mailing Address - Phone:386-446-4210
Mailing Address - Fax:386-445-7309
Practice Address - Street 1:1240 PALM COAST PKWY SW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4700
Practice Address - Country:US
Practice Address - Phone:386-446-4210
Practice Address - Fax:386-445-7309
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90430Medicare UPIN
FLE6656Medicare PIN