Provider Demographics
NPI:1134392863
Name:BONNY S. OLNEY, D.O., P.A.
Entity type:Organization
Organization Name:BONNY S. OLNEY, D.O., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-735-7900
Mailing Address - Street 1:18352 DALLAS PKWY
Mailing Address - Street 2:#136-458
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5227
Mailing Address - Country:US
Mailing Address - Phone:972-735-7900
Mailing Address - Fax:972-735-7902
Practice Address - Street 1:18333 PRESTON RD
Practice Address - Street 2:SUITE #550
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5466
Practice Address - Country:US
Practice Address - Phone:972-735-7900
Practice Address - Fax:972-735-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6638261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG33323Medicare UPIN