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Contact Information

BONNEY LAKE OPTICAL, INC
9801 204TH AVE E
BONNEY LAKE, WA98391-6559
 Phone: 253-750-8135
 Fax: 253-750-8136
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for BONNEY LAKE OPTICAL, INC

NPI # 1154478014
LBN Legal business name BONNEY LAKE OPTICAL, INC
Authorized official SEAN CUDAHY - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 01/04/2007
Last updated 01/31/2023 - About 3 years ago
Identifiers
WA License # 1641
WA Medicaid 2009926
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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