Provider Demographics
NPI:1588749949
Name:BOHON, ALBERT DEAN JR (OD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:DEAN
Last Name:BOHON
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:311 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5309
Mailing Address - Country:US
Mailing Address - Phone:757-547-2777
Mailing Address - Fax:757-436-5217
Practice Address - Street 1:311 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5309
Practice Address - Country:US
Practice Address - Phone:757-547-2777
Practice Address - Fax:757-436-5217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU57032Medicare UPIN
VI0894530001Medicare NSC