Provider Demographics
NPI:1811034713
Name:BONNES-HEIL, TAMARA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN
Last Name:BONNES-HEIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:LYNN
Other - Last Name:BONNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:724 N DIERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4954
Mailing Address - Country:US
Mailing Address - Phone:308-384-9505
Mailing Address - Fax:308-384-4939
Practice Address - Street 1:724 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4954
Practice Address - Country:US
Practice Address - Phone:308-384-9505
Practice Address - Fax:308-384-4939
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 1041152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025072000Medicaid
NE36335OtherBLUE CROSS BLUE SHIELD NE
NE10025072000Medicaid
NE36335OtherBLUE CROSS BLUE SHIELD NE
U44023Medicare UPIN
NEP00110852Medicare PIN
200551209OtherCORP TAX ID NUMBER