NPIMap

Organization Active NPI

David M. Ward, Jr., OD, PA

  • Optometrist
  • Boise, ID
National Provider Identifier
1598825416
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DAVID M. WARD, JR., OD, PA
Practice address
1205 S Five Mile Rd
Boise, ID 83709-1304
Phone
(208) 322-8381
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

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

Authorized official

Name
Dr. Chad H Clark, O.D.NPI 1205241577
Title
Owner/Doctor
Phone
(208) 322-8381

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X ODP-682 ID
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1205 S Five Mile Rd
Boise, ID 83709-1304

Mailing address

1205 S Five Mile Rd
Boise, ID 83709-1304
Phone (208) 322-8381

Other identifiers 4

IdentifierTypeStateIssuer
000010015463OtherIDBLUE SHIELD
6055070001OtherPTAN
V5269OtherIDBLUE CROSS OF IDAHO
806420300MedicaidID

Other names 2

  • Vision Source Boise Doing business as
  • Vision Specialties Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080306000376 ID Part B Supplier - Clinic/Group Practice 7315022902 Receives reassigned benefits from 1 practitioner
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Locations

1205 S Five Mile Rd
Boise, ID 83709
Phone (208) 322-8381

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1598825416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 S FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091304",
            "telephone_number": "208-322-8381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 S FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091304",
            "telephone_number": "208-322-8381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID M. WARD, JR., OD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "208-322-8381",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-682",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010015463",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "6055070001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "V5269",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806420300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source Boise",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vision Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.