Active NPI
Lydia Bouman
- Optometrist
- Medford, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- AT4721
- Practice address
- 1600 N Riverside Ave
Medford, OR 97501-4652 - Phone
- (458) 658-5295
- NPI assigned
- Jun 24, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | AT4721 | OR | Primary |
Addresses
Primary practice location
1600 N Riverside Ave
Medford, OR 97501-4652
Mailing address
3420 S Cottage Grove Ave Apt 801
Chicago, IL 60616-5112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT4721 | OR | MD | Optometrist |
| 4721 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Eye Group, PC | Optometrist | Current | Accepting new patients |
Locations
63455 N Highway 97
Ste 75
Bend, OR 97703
Phone (541) 388-7906
265 Valley River Ctr
Eugene, OR 97401
Phone (541) 345-6988
970 NW Eastman Pkwy
Gresham, OR 97030
Phone (503) 666-7460
1600 N Riverside Ave
Medford, OR 97501
Phone (541) 776-6966
799 Lancaster Dr NE
Ste 120
Salem, OR 97301
Phone (503) 364-4896
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Bend, OR
- NPI 1831656925
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719187200000",
"number": "1003650904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3420 S COTTAGE GROVE AVE APT 801",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606165112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 N RIVERSIDE AVE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975014652",
"telephone_number": "458-658-5295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUMAN",
"first_name": "LYDIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-24",
"last_updated": "2024-06-24",
"certification_date": "2024-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "AT4721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.