Active NPI
Miguel Angel Bosch, OD
- Optometrist
- Augusta, GA
National Provider Identifier
1750464178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 001096
- Practice address
- 3450 Wrightsboro Rd
Suite 1325
Augusta, GA 30909-0566 - Phone
- (706) 736-9929
- Fax
- (706) 736-9967
- NPI assigned
- Oct 21, 2006
- Last updated
- Oct 20, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 001096 | GA | Primary |
Addresses
Primary practice location
3450 Wrightsboro Rd
Suite 1325
Augusta, GA 30909-0566
Mailing address
3450 Wrightsboro Rd
Suite 1325
Augusta, GA 30909-0566
Phone (706) 736-9929
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111122000198 | GA | Practitioner - Optometry | 9830363258 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001096 | GA | MD | Optometrist |
Organizations & group practices 1
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": "1161388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319068800000",
"number": "1750464178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3450 WRIGHTSBORO RD",
"address_2": "SUITE 1325",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309090566",
"telephone_number": "706-736-9929",
"fax_number": "706-736-9967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 WRIGHTSBORO RD",
"address_2": "SUITE 1325",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309090566",
"telephone_number": "706-736-9929",
"fax_number": "706-736-9967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSCH",
"first_name": "MIGUEL",
"middle_name": "ANGEL",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-21",
"last_updated": "2011-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "001096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.