Basic Information
| Provider Information | |||||||||
| NPI: | 1811635329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONNEAU | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 269 LAIRD AVENUE | ||||||||
| Address2: | |||||||||
| City: | ESSEX | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | N8M1S7 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 1945 CEI DR | ||||||||
| Address2: | |||||||||
| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139845133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2022 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT.007035 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.