Dan R Boardsen OD PC
Organization Active NPI Optometrist · Moberly, MO
NPI 1992886311 · NPPES record last updated Sep 30, 2014
Key facts
- NPI
- 1992886311
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- T02681 (MO)
- Legal business name
- DAN R BOARDSEN OD PC
- Practice address
- 541 West Reed
Moberly, MO 65270 - Phone
- (660) 263-3737
- Fax
- (660) 263-2375
- NPI assigned
- Oct 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Dan R Boardsen, OD
- Title
- Owner
- Phone
- (660) 263-3737
Practitioners 1
-
Danny R. Boardsen, OD PC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080124000101 | MO | Part B Supplier - Clinic/Group Practice | 3971685371 |
Receives reassigned benefits from 1 practitioner Practice locations: Moberly, MO |
National Provider Directory
Locations
541 W Reed St
Moberly, MO 65270
Phone (660) 263-3737
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | T02681 | MO | Yes |
Addresses
Primary practice location
541 West Reed
Moberly, MO 65270
Mailing address
PO Box 400
Moberly, MO 65270-0400
Phone (660) 263-3737
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 312290307 | Medicaid | MO | |
| 431466559 | Other | VSP | |
| 5221 | Other | DAVIS VISION |
Other providers in Moberly, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2014. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.