Gregory A Boomer

Primary specialty

OptometristTaxonomy code 152W00000X

License

6622T Issued in CA

Practice address

607 A Cottage St
Susanville, CA 96130-4303

Phone

(530) 257-4424

Fax

(530) 257-9626

NPI assigned

Nov 14, 2006

Last updated

Jun 5, 2008By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Troy Humphreys OD Faao, Professional Corporation

  dba Legacy Optometry

  • Optometrist
  • Susanville, CA
  • NPI 1326660960
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212624000000",
    "number": "1326110354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 A COTTAGE ST",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961304303",
            "telephone_number": "530-257-4424",
            "fax_number": "530-257-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 A COTTAGE ST",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961304303",
            "telephone_number": "530-257-4424",
            "fax_number": "530-257-9626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMER",
        "first_name": "GREGORY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6622T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorraine Louise Barber, LVN
• Tommie Beard
• Emily Bird
• Brandon Blosser
• Vanessa Bonilla
• Michael Julian Boretz, L.C.S.W.
• Adrian Bowers, PH.D.
• Steven Eric Braatz, MD
• Braden Partners LP (Pacific Pulmonary Services)
• Angela Brandt, PHARMD

• Optometrist in Susanville, CA
• Providers in Susanville, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.