Theodore E Bogart, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007165 Issued in IL

Practice address

West Route 16
Shelbyville, IL 62565-0199

Phone

(217) 774-4422

Fax

(217) 774-4722

NPI assigned

Oct 25, 2006

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

Other identifiers 1

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 and National Provider Directory roles.

• Center for Sight of Central Illinois SC

  dba Central Illinois Vision Center

  • Ophthalmology Physician
  • Decatur, IL
  • NPI 1093854820

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355875200000",
    "number": "1609950401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 199",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625650199",
            "telephone_number": "217-774-4422",
            "fax_number": "217-774-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WEST ROUTE 16",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625650199",
            "telephone_number": "217-774-4422",
            "fax_number": "217-774-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGART",
        "first_name": "THEODORE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007165",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy Lynn Barnett, MS
• Matthew Paul Bell, DMD
• Beyers Family Chiropractic, LTD.
• Matthew Todd Beyers, D.C.
• Caitlin Bird, APRN
• Samantha Bonny
• Doris Ann Bowers, M.D.
• Richard Dwayne Brown, DMD
• Katelynn E Buhrmester
• Stephanie Javue Burrell, LPN

• Optometrist in Shelbyville, IL
• Providers in Shelbyville, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; 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.