Cole Boboth

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60469574 Issued in WA

Practice address

403 N Euclid St
Grandview, WA 98930-9407

Phone

(509) 882-2650

Fax

(509) 882-4225

NPI assigned

Oct 19, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boboth Vision Clinic Wa PLLCGroup PAC ID 7517207756, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Boboth Vision Clinic Wa, PLLC

  • Optometrist
  • Grandview, WA
  • NPI 1699256008
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1598040644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 N EUCLID ST",
            "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 ST",
            "city": "GRANDVIEW",
            "state": "WA",
            "postal_code": "989309407",
            "telephone_number": "509-882-2650",
            "fax_number": "509-882-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBOTH",
        "first_name": "COLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-19",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60469574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN",
            "identifier": "91-1936651",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2021554",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Val Betts, PHARMD
• Troy A Binfet, D.C.
• Mackenzie Blackwell, PMHNP-BC
• Guadalupe Bobadilla
• Boboth Vision Clinic Wa, PLLC
• Everett Boboth, O.D.
• Fred C Boboth, O.D., P.S.
• Blake J Bond, M.D.
• Kristin L. Bond, M.D.
• Roger Bovey, RPH

• 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 Sep 10, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.