Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3656 | MA |
NPI | 1003977661 |
---|---|
Provider Name | Dr. John-Michael Joseph Bona |
First Address | Marblehead, MA 01945-2146 |
Second Address | Marblehead, MA 01945-2146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 14/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0371530 | (05) | MA |
U67802 | (02) | MA |