Everett Boboth, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60293170 Issued in WA

Practice address

403 N Euclid St
Grandview, WA 98930-9407

Phone

(509) 882-2650

Fax

(509) 882-4225

NPI assigned

Jun 20, 2012

Last updated

Jun 20, 2012By the provider in NPPES

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

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, 2012

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Boboth Vision Clinic Wa, PLLC

  dba Boboth Vision Clinic

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

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1790048163",
    "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": "EVERETT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60293170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Troy A Binfet, D.C.
• Mackenzie Blackwell, PMHNP-BC
• Guadalupe Bobadilla
• Boboth Vision Clinic Wa, PLLC (Boboth Vision Clinic)
• Cole Boboth
• Fred C Boboth, O.D., P.S.
• Blake J Bond, M.D.
• Kristin L. Bond, M.D.
• Roger Bovey, RPH
• Sandra Bravo, ARNP

• 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 Jun 20, 2012; 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.