Fred C Boboth, O.D., P.S.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1634TX Issued in WA

Practice address

403 N Euclid Rd
Grandview, WA 98930-9407

Phone

(509) 882-2650

Fax

(509) 882-4225

NPI assigned

Jan 22, 2007

Last updated

Apr 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Boboth Vision Clinic Wa, PLLC

  dba Boboth Vision Clinic

  • Optometrist
  • Grandview, WA
  • NPI 1699256008
  Medicare reassignment NPD
• Fred C. Boboth O.D., P.S.

  dba Boboth Vision Clinic

  • Optometrist
  • Grandview, WA
  • NPI 1003017476
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365552000000",
    "number": "1194879700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 N EUCLID RD",
            "city": "GRANDVIEW",
            "state": "WA",
            "postal_code": "989309407",
            "telephone_number": "509-882-2650",
            "fax_number": "509-882-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 N EUCLID RD",
            "city": "GRANDVIEW",
            "state": "WA",
            "postal_code": "989309407",
            "telephone_number": "509-882-2650",
            "fax_number": "509-882-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBOTH",
        "first_name": "FRED",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D., P.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2013-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1634TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME REGION D SUPPLIER NO",
            "identifier": "0317360001",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS ID NO REGION WEST",
            "identifier": "G8902905",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "71549",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH NORTHWEST",
            "identifier": "911936651",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NO",
            "identifier": "BO4392",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "911936651",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "010062119",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2021554",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Blackwell, PMHNP-BC
• Guadalupe Bobadilla
• Boboth Vision Clinic Wa, PLLC (Boboth Vision Clinic)
• Cole Boboth
• Everett Boboth, O.D.
• Blake J Bond, M.D.
• Kristin L. Bond, M.D.
• Roger Bovey, RPH
• Sandra Bravo, ARNP
• Paige Briggs, RD

• Optometrist in Grandview, WA
• Providers in Grandview, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; 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.

Verify at the official NPI Registry.