Individual provider Active NPI

David M Boeckman, OD

  • Optometrist
  • Conroe, TX
National Provider Identifier
1891767992
Registry record updated Dec 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TX3012TG Issued in TX
Practice address
1422 B Loop 336 W
Conroe, TX 77304
Phone
(936) 539-2020
Fax
(936) 756-7916
NPI assigned
Feb 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TX3012TG TX Primary

Addresses

Primary practice location

1422 B Loop 336 W
Conroe, TX 77304

Mailing address

1422 B Loop 336 W
Conroe, TX 77304
Phone (936) 539-2020

Other identifiers 1

IdentifierTypeStateIssuer
11232830ZMedicaidTX

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20101022000087 TX Practitioner - Optometry 6305741646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1982
Medicare assignment
May accept Medicare assignment
Group practices
Conroe Vision Associates PAGroup PAC ID 0648550988, 4 clinicians

Practice addresses (Care Compare)

1422 N Loop 336
Suite B
Conroe, TX 77304-3540
Phone (936) 539-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TX3012TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Conroe Vision Associates PA Optometrist CurrentSince Oct 8, 2016 Accepting new patients

Locations

1422 N Loop 336 W
Ste B
Conroe, TX 77304
Phone (936) 539-2020

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419206400000",
    "number": "1891767992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1422 B LOOP 336 W",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "77304",
            "telephone_number": "936-539-2020",
            "fax_number": "936-756-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1422 B LOOP 336 W",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "77304",
            "telephone_number": "936-539-2020",
            "fax_number": "936-756-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOECKMAN",
        "first_name": "DAVID",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2014-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "TX3012TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11232830Z",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.