Jorge L. Bonilla Davila, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

149 Issued in PR

Practice address

2053 Ponce by Pass
Suite 104
Ponce, PR 00717-1306

Phone

(787) 848-2885

Fax

(787) 848-4496

NPI assigned

Aug 15, 2005

Last updated

Jan 26, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optometry World Ponce

  • Primary Care Clinic/Center
  • Ponce, PR
  • NPI 1609314871
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485388800000",
    "number": "1053303289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2053 PONCE BY PASS",
            "address_2": "SUITE 104",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007171306",
            "telephone_number": "787-848-2885",
            "fax_number": "787-848-4496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2053 PONCE BY PASS",
            "address_2": "SUITE 104",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007171306",
            "telephone_number": "787-848-2885",
            "fax_number": "787-848-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA DAVILA",
        "first_name": "JORGE",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2017-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PR",
            "license": "149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053303289",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adriana Maria Bolanos
• Guillermo Bolanos, MD
• Victor Antonio Bolanos
• Yezmin H Bolanos, M.D.
• Bonati Medica LLC
• Paola Gybelle Bonilla Hernandez
• Gabriel Enrique Bonilla Maldonado
• Jose Javier Bonilla Pizarro
• Carlos Antonio Bonilla-Ruiz
• Brandon Bonilla

• Optometrist in Ponce, PR
• Providers in Ponce, PR by specialty
• Optometrist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.