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

3605 Mayfair Ave
Ste 2150
Hibbing, MN 55746-2923

Phone

(218) 262-3156

Fax

(218) 262-1456

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Timothy C Bonner, MD

Title

President

Phone

(218) 326-3433

Specialties & licenses 2

Addresses

Other names 1

• BONNER EYE CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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
  • Grand Rapids, MN
  • NPI 1053351817

  O20040610000493

  Same enrollment

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Bonner Eye Clinic Optical LLC

  • Durable Medical Equipment & Medical Supplies
  • Grand Rapids, MN
  • NPI 1093287849

  Member Of

  NPD member

Locations

Practitioners 5

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
  NPD
• M. Jerry Zapanta Mariano, M.D.

  • Ophthalmology Physician
  • Grand Rapids, MN
  • NPI 1376582908
  NPD
• Abby Sperr, OD

  • Optometrist
  • Grand Rapids, MN
  • NPI 1750066718
  NPD
• Michael C. Young, OD

  • Optometrist
  • Grand Rapids, MN
  • NPI 1932434016
  NPD
• Richard Crescent Rotella, M.D.

  • Ophthalmology Physician
  • Redington Beach, FL
  • NPI 1386755825
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1770626616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD",
            "address_2": "STE 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": "3605 MAYFAIR AVE",
            "address_2": "STE 2150",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462923",
            "telephone_number": "218-262-3156",
            "fax_number": "218-262-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN L BONNER EYE CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-326-3433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BONNER EYE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Jacobs, PHARM D
• Jacobson Family Dentistry P.C.
• Heathere Marie Jacobson, PHARMD
• Patrecia Taplin Jacobson, DDS
• Dawn Bremer Jenkins, MSSW LICSW
• Anita K Johnson-Hoehne, CNP
• Dana Ruthe Johnson
• Kimberly Louise Johnson, R.D.L.D.,CDE
• Mark Johnson
• Meredith Q Johnson, RD/LD

• Ophthalmology Physician in Hibbing, MN
• Providers in Hibbing, MN by specialty
• Ophthalmology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.