Bonner Eye Clinic Optical LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

BONNER EYE CLINIC OPTICAL LLC

Practice address

1542 Golf Course Rd Ste 201
Grand Rapids, MN 55744-3537

Phone

(218) 326-3433

Fax

(218) 326-3435

NPI assigned

Dec 18, 2018

Last updated

Dec 18, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Manuel Jerry Mariano, M.D.

Title

Owner/President

Phone

(218) 326-3433

Specialties & licenses 1

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• John L Bonner Eye Clinic LTD

  dba Bonner Eye Clinic

  • Ophthalmology Physician
  • Hibbing, MN
  • NPI 1770626616

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• M. Jerry Zapanta Mariano, M.D.

  • Ophthalmology Physician
  • Grand Rapids, MN
  • NPI 1376582908
  NPD

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

{
    "created_epoch": "1545091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545091200000",
    "number": "1093287849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD STE 201",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443537",
            "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 STE 201",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443537",
            "telephone_number": "218-326-3433",
            "fax_number": "218-326-3435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3605 Mayfair Ave Ste 2150",
            "address_purpose": "LOCATION",
            "city": "Hibbing",
            "state": "MN",
            "postal_code": "557462938",
            "country_code": "US",
            "telephone_number": "218-262-3156",
            "fax_number": "218-326-3435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BONNER EYE CLINIC OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-18",
        "last_updated": "2018-12-18",
        "status": "A",
        "authorized_official_last_name": "MARIANO",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "JERRY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "218-326-3433",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renada Bjordal, SLP
• Andrew Morris Blair
• Fredrick Bruce Blaisdell, MD
• Katrina Marie Boden, CNP
• Bonham Psychotherapy Services
• Timothy Charles Bonner, M.D.
• Borealis Health PLLC
• Rachel Marie Bougalis, LPCC
• Emily Kathryn Bounds, OTR
• Lisa Ann Brandt, RPH

• Durable Medical Equipment & Medical Supplies in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Durable Medical Equipment & Medical Supplies in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.