Active NPI
Boling Vision Center, LLC
- Ophthalmology Physician
- Elkhart, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- BOLING VISION CENTER, LLC
- Practice address
- 2746 Old US 20 W
Elkhart, IN 46514-1364 - Phone
- (574) 293-3545
- Fax
- (574) 522-0599
- NPI assigned
- Jun 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Richard C Boling II, MD
- Title
- Owner
- Phone
- (574) 293-3545
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | Primary |
Addresses
Primary practice location
2746 Old US 20 W
Elkhart, IN 46514-1364
Mailing address
2746 Old US 20 W
Elkhart, IN 46514-1364
Phone (574) 293-3545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DF9809 | Other | RAILROAD MEDICARE | |
| C15688 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070413000459 | IN | Part B Supplier - Clinic/Group Practice | 6103921556 |
Receives reassigned benefits from 14 practitioners Practice locations: South Bend, IN; Mishawaka, IN; Goshen, IN; Elkhart, IN |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Boling Vision Center LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Eyewear Supplier
- Elkhart, IN
- NPI 1336272673
Locations
2746 US Highway 20 W
Elkhart, IN 46514
Phone (574) 293-3545
2746 US Highway 20 W
Ste B
Elkhart, IN 46514
Phone (574) 293-3545
4455 Edison Lakes Pkwy
#B
Mishawaka, IN 46545
Phone (574) 968-0136
2004 Edison Rd
South Bend, IN 46617
Practitioners & affiliated clinicians
Practitioners 14
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmology Physician
- Elkhart, IN
- NPI 1245278068
IN, Ophthalmology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1204675200000",
"number": "1003851445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2746 OLD US 20 W",
"city": "ELKHART",
"state": "IN",
"postal_code": "465141364",
"telephone_number": "574-293-3545",
"fax_number": "574-522-0599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2746 OLD US 20 W",
"city": "ELKHART",
"state": "IN",
"postal_code": "465141364",
"telephone_number": "574-293-3545",
"fax_number": "574-522-0599"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BOLING VISION CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-19",
"last_updated": "2008-03-05",
"status": "A",
"authorized_official_last_name": "BOLING",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "574-293-3545",
"authorized_official_name_suffix": "II",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DF9809",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "C15688",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.