BONNER EYE CLINIC OPTICAL LLC NPI 1093287849

NPI Information

  • NPI: 1093287849
  • Provider Name: BONNER EYE CLINIC OPTICAL LLC
  • Classification: Durable Medical Equipment & Medical Supplies - 332B00000X
  • Entity Type: Organization
  • CLIA Number: 24D2076445
  • Address: 1542 GOLF COURSE RD STE 201
    GRAND RAPIDS, MN
    ZIP 55744
  • Phone: (218) 326-3433

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NPI Details

BONNER EYE CLINIC OPTICAL LLC is a durable medical equipment medical supplies in Grand Rapids, MN. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. BONNER EYE CLINIC OPTICAL LLC NPI is 1093287849. The provider is registered as an organization entity type.

The provider's business location address is:

1542 GOLF COURSE RD STE 201
GRAND RAPIDS, MN
ZIP 55744-537
Phone: (218) 326-3433
Fax: (218) 326-3435

The provider's authorized official is Manuel Jerry Mariano .
The authorized official title is Owner/president and has the following contact phone number (218) 326-3433.

The CLIA number assigned to this NPI record is 24D2076445 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/18/2018 and was last updated on 12/18/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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