DR. DEREK JOHN BONACCI (NPI# 1356572804) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356572804 |
| Entity Type | Individual |
| Full Name | DR. DEREK JOHN BONACCI |
| Credential | O.D. |
| Practice Address |
2055 15th St N Saint Cloud MN 56303-1747 |
| Practice Telephone | 3202511432 |
| Practice Fax Number | 3202517122 |
| Mailing Telephone | 3202511432 |
| Mailing Fax Number | 3202517122 |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2018-03-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 3170 | MN | Eye and Vision Services Providers |
| Street Address |
2055 15TH ST N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-1747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396733143 | Mitchell Dean Harstad | Optometrist | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-06 |
| 1043650575 | Joel W Nelson | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2013-06-28 |
| 1467499293 | St Cloud Mn Ophthalmology Asc LLC | Clinic/Center | 2055 15th St N, Suite B, Saint Cloud, MN 56303-1747 | 2006-06-01 |
| 1538157805 | St Cloud Eye Clinic Pa | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-11 |
| 1376531079 | Steven William Rice | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-07 |
| 1548258221 | Bradley Myren Anderson | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-07 |
| 1083602783 | Richard William Lucius | Ophthalmology | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-07 |
| 1427046267 | St Cloud Opticians | Eyewear Supplier (Equipment, not the service) | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770010613 | Shalon Ann Ronning | Optometrist | 1545 Northway Dr Ste 120, Saint Cloud, MN 56303-1941 | 2017-05-22 |
| 1982942520 | Jaime Delgado | Optometrist | 5086 Whitewater Way, Saint Cloud, FL 34771-7970 | 2013-01-16 |
| 1134353170 | Kawashaway Eyecare | Optometrist | 3112 20th St S, Saint Cloud, MN 56301-4709 | 2009-05-05 |
| 1487798302 | Jeffrey Pearson | Optometrist | 4201 W Division St Ste 61, Saint Cloud, MN 56301-3693 | 2007-02-16 |
| 1558425058 | John Huyler | Optometrist | 4201 W Division St Ste 90, Saint Cloud, MN 56301-4546 | 2006-12-20 |
| 1790857472 | Emily Suzanne Dold Schwartz | Optometrist | 901w Saint Germain St, Saint Cloud, MN 56301-3460 | 2006-11-15 |
| 1023120763 | Gordon Eugene Dramen | Optometrist | 380 33rd Ave S, Saint Cloud, MN 56301-3716 | 2006-08-31 |
| 1437194024 | Robert Sartoris | Optometrist | 325 33rd Ave N, Suite 102, Saint Cloud, MN 56303-3041 | 2006-06-18 |
| 1033193511 | Douglas Gross | Optometrist | 207 County Road 120, Saint Cloud, MN 56303-4872 | 2005-11-30 |
| 1396733143 | Mitchell Dean Harstad | Optometrist | 2055 15th St N, Saint Cloud, MN 56303-1747 | 2005-10-06 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.