Timothy Charles Bonner, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

27813 Issued in MN

Practice address

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

Phone

(218) 326-3433

Fax

(218) 326-3435

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431993600000",
    "number": "1366498784",
    "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": {
        "last_name": "BONNER",
        "first_name": "TIMOTHY",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2015-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "27813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225067500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "27813",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Morris Blair
• Fredrick Bruce Blaisdell, MD
• Katrina Marie Boden, CNP
• Bonham Psychotherapy Services
• Bonner Eye Clinic Optical LLC
• Borealis Health PLLC
• Rachel Marie Bougalis, LPCC
• Emily Kathryn Bounds, OTR
• Lisa Ann Brandt, RPH
• Michael Allen Brandt, RPH

• 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 May 19, 2015; 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.