NPIMap

Individual provider Active NPI

Thomas E Boulden, OD

  • Optometrist
  • Tomah, WI
National Provider Identifier
1427052182
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2618 Issued in WI
Practice address
325 Butts Ave
Tomah, WI 54660-1412
Phone
(608) 372-5951
NPI assigned
Jun 10, 2005
Last updated
Sep 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2618 WI Primary

Addresses

Primary practice location

325 Butts Ave
Tomah, WI 54660-1412

Mailing address

PO Box 1510
Eau Claire, WI 54702-1510
Phone (608) 372-5951

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tboulden25586@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051026000371 WI Practitioner - Optometry 0840217113 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic Health System-Southwest Wisconsin Region IncGroup PAC ID 0345152443, shared by 9 NPIs, 539 clinicians

Practice addresses (Care Compare)

700 W Ave S
La Crosse, WI 54601-4783
Phone (608) 785-0940

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2618WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Jun 26, 2018 Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. CurrentSince Jun 26, 2018 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince May 1, 2006 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. Current Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince May 1, 2006 Accepting new patients
Gundersen Lutheran Express Care, Inc Past Accepting new patients
Gundersen Clinic, LTD. Optometrist Past Accepting new patients
Mayo Clinic Health System-Northwest Wisconsin Region, Inc. Past Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. Past Accepting new patients
Gundersen Clinic LTD Past Accepting new patients

Locations

733 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 838-3806

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

310 W Main St
Sparta, WI 54656
Phone (608) 269-1700

325 Butts Ave
Tomah, WI 54660
Phone (608) 372-5951

Interoperability endpoints

  • Direct secure messaging: tboulden25586@ehrdirect.mayoclinicmsg.org
  • Direct secure messaging: tboulden636351@direct.emplifyhealth.org

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1427052182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021510",
            "telephone_number": "608-372-5951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 BUTTS AVE",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546601412",
            "telephone_number": "608-372-5951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDEN",
        "first_name": "THOMAS",
        "middle_name": "E",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tboulden25586@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "325 Butts Ave",
            "city": "Tomah",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546601412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tomah, WI

Sources for this page

Verify at the official NPI Registry.