John S Bonebrake, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

T02478 Issued in MO

Practice address

707 N 36TH St
Suite a
Saint Joseph, MO 64506-2968

Phone

(816) 279-5683

Fax

(816) 279-5685

NPI assigned

Jul 19, 2005

Reactivated

Mar 27, 2006

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1194724328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N 36TH ST",
            "address_2": "SUITE A",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062968",
            "telephone_number": "816-279-5683",
            "fax_number": "816-279-5685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N 36TH ST",
            "address_2": "SUITE A",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062968",
            "telephone_number": "816-279-5683",
            "fax_number": "816-279-5685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONEBRAKE",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2023-03-07",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311944706",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410048243",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "108900",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS",
            "identifier": "200111698",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bob Ruwwe Jr. DDS PC
• Kenneth Pacana Boc, MD
• Shawn C Boehm, DDS,MD
• Patricia A. Boice, D.D.S., M.S.
• Bonebrake Vision & Eye Center LLC
• Beth L Booker, RN, BC, FNP
• Linda A Borger, SLP-CCC
• Staci J Boswell, PTA
• John Michael Bosworth, RPH
• Michael Dale Bower, RPH

• Optometrist in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.