NPIMap

Organization Active NPI

Boardman Family Eye Care PC

  • Optometrist
  • Wysox, PA
National Provider Identifier
1366627275
Registry record updated Oct 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000896 Issued in PA
Legal business name
BOARDMAN FAMILY EYE CARE PC
Practice address
889 Craftmaster Road
Wysox, PA 18854-0000
Phone
(570) 265-3668
Fax
(570) 265-8936
NPI assigned
Jan 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2011

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

Authorized official

Name
Avery Boardman, ODNPI 1073603718
Title
Owner
Phone
(570) 265-3668

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OEG000896 PA Primary
Durable Medical Equipment & Medical Supplies 332B00000X OEG000896 PA

Addresses

Primary practice location

889 Craftmaster Road
Wysox, PA 18854-0000

Mailing address

889 Craftmaster Road
PO Box 331
Wysox, PA 18854-0000
Phone (570) 265-3668

Other identifiers 1

IdentifierTypeStateIssuer
DR8207OtherPAMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319414400000",
    "number": "1366627275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "889 CRAFTMASTER ROAD",
            "address_2": "PO BOX 331",
            "city": "WYSOX",
            "state": "PA",
            "postal_code": "188540000",
            "telephone_number": "570-265-3668",
            "fax_number": "570-265-8936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "889 CRAFTMASTER ROAD",
            "city": "WYSOX",
            "state": "PA",
            "postal_code": "188540000",
            "telephone_number": "570-265-3668",
            "fax_number": "570-265-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARDMAN FAMILY EYE CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2011-10-24",
        "status": "A",
        "authorized_official_last_name": "BOARDMAN",
        "authorized_official_first_name": "AVERY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-265-3668",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000896",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "OEG000896",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DR8207",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wysox, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; 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.