John L Bonner Eye Clinic LTD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

432 Issued in MN

Legal business name

JOHN L BONNER EYE CLINIC LTD

Practice address

1542 Golf Course Rd
Suite 201
Grand Rapids, MN 55744-9603

Phone

(218) 326-3433

Fax

(218) 326-3435

NPI assigned

Jun 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Timothy Charles Bonner, M.D.

Title

President

Phone

(218) 326-3343

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• John L Bonner Eye Clinic LTD

  • Ophthalmology Physician
  • Hibbing, MN
  • NPI 1770626616

  O20040610000493

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• Direct secure messaging: asperr@bonner.intellechartdirect.net
• Direct secure messaging: gcarlisle@bonner.intellechartdirect.net
• Direct secure messaging: jmariano@bonner.intellechartdirect.net
• Direct secure messaging: myoung@bonner.intellechartdirect.net

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Grant Robert Carlisle

  • Ophthalmology Physician
  • Grand Rapids, MN
  • NPI 1063075224
  Medicare reassignment Care Compare group NPD
• M. Jerry Zapanta Mariano, M.D.

  • Ophthalmology Physician
  • Grand Rapids, MN
  • NPI 1376582908
  Medicare reassignment Care Compare group NPD
• Abby Sperr, OD

  • Optometrist
  • Grand Rapids, MN
  • NPI 1750066718
  Medicare reassignment Care Compare group NPD
• Michael C. Young, OD

  • Optometrist
  • Grand Rapids, MN
  • NPI 1932434016
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1053351817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD",
            "address_2": "SUITE 201",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557449603",
            "telephone_number": "218-326-3433",
            "fax_number": "218-326-3435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD",
            "address_2": "SUITE 201",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557449603",
            "telephone_number": "218-326-3433",
            "fax_number": "218-326-3435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN L BONNER EYE CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-326-3343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "432",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0186560001",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lana Rae Jacobson, FAMILY NURSE PRACTIT
• James Rostvold
• Jason Jarvis, LPCC
• Kelley L Jensen, APRN, CNP
• Lee Dale Jess, D.D.S.
• Amber L. Johnson, CRNA
• David Johnson, RPH
• James Frederick Johnson, D.D.S.
• Kathryn Lynn Johnson
• Lanea D Johnson, OTR/L

• Ophthalmology Physician in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Ophthalmology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.