Organization
BONNER EYE CLINIC OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL JERRY MARIANO M.D. (OWNER/PRESIDENT)
(218) 326-3433
Entity
Organization
Contact information
Practice address
1542 GOLF COURSE RD STE 201, GRAND RAPIDS, MN 55744-3537
(218) 326-3433
(218) 326-3435
Mailing address
1542 GOLF COURSE RD STE 201, GRAND RAPIDS, MN 55744-3537
(218) 326-3433
(218) 326-3435
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/18/2018
Last updated
12/18/2018
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