Brooke Kelly Bonilla, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34390 Issued in CA

Practice address

852 S Grand Ave
Glendora, CA 91740-4806

Phone

(626) 914-4815

NPI assigned

Oct 10, 2019

Last updated

Oct 10, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Glendora Optometry Apc

  • Health Service Clinic/Center
  • Glendora, CA
  • NPI 1811666506
  NPD
• Randy R Burt, OD Inc.

  • Optometrist
  • Glendora, CA
  • NPI 1851535900
  NPD (past)

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1902448954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 S WABASH AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917416221",
            "telephone_number": "971-258-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 S GRAND AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404806",
            "telephone_number": "626-914-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "BROOKE",
        "middle_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Bohm, M.S., M.DIV
• Martin A. Bohorquez, M.D.
• Shelby H Bollenbacher, LCSW
• David L Bolton, D.C.
• Bones Management, Inc. (Sierra Pharmacy)
• Christine Bou Sleiman, RDN
• Guadalupe Garcia Boudreaux, APCC
• Najib Bouz, M.D.
• Stephen Warren Bowen, D.M.D.
• Lori Boyer

• Optometrist in Glendora, CA
• Providers in Glendora, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.