Healthcare Provider Details

I. General information

NPI: 1811034713
Provider Name (Legal Business Name): TAMARA LYNN BONNES-HEIL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA LYNN BONNES O.D.

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N DIERS AVE
GRAND ISLAND NE
68803-4954
US

IV. Provider business mailing address

724 N DIERS AVE
GRAND ISLAND NE
68803-4954
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-9505
  • Fax: 308-384-4939
Mailing address:
  • Phone: 308-384-9505
  • Fax: 308-384-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNE 1041
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberNE 1041
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberNE 1041
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberNE 1041
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: