Provider Demographics
NPI:1144339094
Name:SEELY, BONNIE KATHLEEN (OD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:KATHLEEN
Last Name:SEELY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 TALBERT DRIVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-893-1695
Mailing Address - Fax:530-893-2458
Practice Address - Street 1:2056 TALBERT DRIVE
Practice Address - Street 2:SUITE #100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-893-1695
Practice Address - Fax:530-893-2458
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6345T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0063450Medicaid
CA1217790001Medicare NSC
U21164Medicare UPIN