David R. Boniface, O.D.
Individual provider Active NPI Optometrist · Calexico, CA
NPI 1992810592 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1992810592
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 6874T (CA)
- Practice address
- 329 W 2ND St
Calexico, CA 92231-2114 - Phone
- (760) 357-2712
- Fax
- (760) 357-5710
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080220000570 | CA | Practitioner - Optometry | 9032293626 | Practice locations: Calexico, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6874T | CA | MD | Optometrist |
| 6874 | CA | MD | Speech-Language Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 6874T | CA | Yes |
Addresses
Primary practice location
329 W 2ND St
Calexico, CA 92231-2114
Mailing address
329 W 2ND St
Calexico, CA 92231-2114
Phone (760) 357-2712
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0068740 | Medicaid | CA |
Other providers in Calexico, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.