Cameron Fredrick Boboth, OD
Individual provider Active NPI Optometrist · Fort Smith, AR
NPI 1043733744 · NPPES record last updated Mar 5, 2019
Key facts
- NPI
- 1043733744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2766 (AR)
- Practice address
- 1021 S Waldron Rd
Fort Smith, AR 72903 - Phone
- (479) 478-8860
- Fax
- (479) 478-8860
- NPI assigned
- Jul 25, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Boboth Vision Clinic Wa PLLC
Practice addresses (Care Compare)
1023 W Wine Country Rd
Grandview, WA 98930-1041
Phone (509) 882-2650
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in AR, WA, AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180529001416 | AR | Practitioner - Optometry | 9234494055 | Reassigns benefits to 1 organization |
| I20200204001990 | WA | Practitioner - Optometry | 9234494055 | Reassigns benefits to 1 organization |
| I20241105003132 | AZ | Practitioner - Optometry | 9234494055 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2766 | AR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boboth Vision Clinic Wa, PLLC | Optometrist | Current |
Accepting new patients |
| Arkansas Vision Development Center PA | Vision Therapy | Current |
Accepting new patients |
Locations
1021 S Waldron Rd
Fort Smith, AR 72903
Phone (479) 478-8860
403 N Euclid St
Grandview, WA 98930
Phone (509) 402-9020
1023 W Wine Country Rd
Grandview, WA 98930
Phone (509) 882-2650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2766 | AR | Yes |
| Vision Therapy Optometrist | 152WV0400X | 2766 | AR | |
| Pediatric Optometrist | 152WP0200X | 2766 | AR |
Addresses
Primary practice location
1021 S Waldron Rd
Fort Smith, AR 72903
Mailing address
1021 S Waldron Rd
Fort Smith, AR 72903-2549
Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.