Organization
JOHN L BONNER EYE CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY CHARLES BONNER M.D. (PRESIDENT)
(218) 326-3343
Entity
Organization
Contact information
Practice address
1542 GOLF COURSE RD, SUITE 201, GRAND RAPIDS, MN 55744-9603
(218) 326-3433
(218) 326-3435
Mailing address
1542 GOLF COURSE RD, SUITE 201, GRAND RAPIDS, MN 55744-9603
(218) 326-3433
(218) 326-3435
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
432
MN
207W00000X
Ophthalmology Physician
Primary
432
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0186560001
DMERC
MN
Enumeration date
06/08/2006
Last updated
10/17/2007
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