Provider Demographics
NPI:1356413330
Name:TONNER, STEPHEN PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:TONNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8053 E BLOOMINGTON FWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1002
Mailing Address - Country:US
Mailing Address - Phone:952-224-2883
Mailing Address - Fax:
Practice Address - Street 1:8053 E BLOOMINGTON FWY
Practice Address - Street 2:SUITE 550
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1002
Practice Address - Country:US
Practice Address - Phone:952-224-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist