Boboth, Fred C

Boboth, Fred C is an sole proprietor health care provider with primary practice located at 403 N Euclid Rd , Grandview WA 98930-9407. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Boboth, Fred C can be contacted via phone (509) 882-2650.

Contact Information

Primary practice address
403 N Euclid Rd Grandview WA 98930-9407
Phone: (509) 882-2650
Fax: (509) 882-4225
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1634TX Washington

Profile Details

NPI number 1194879700
LBN Legal business name Boboth, Fred C
Credentials O.D., P.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 22nd, 2007
Last updated Apr 10th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194879700 NPPES
Washington Other 0317360001 DME REGION D SUPPLIER NO
Washington Other G8902905 DME REGION D SUPPLIER NO
Washington Other 71549 DME REGION D SUPPLIER NO
Washington Other 911936651 DME REGION D SUPPLIER NO
Washington Other BO4392 DME REGION D SUPPLIER NO
Washington Other 911936651 DME REGION D SUPPLIER NO
Washington Other 010062119 DME REGION D SUPPLIER NO
Washington MEDICAID 2021554 DME REGION D SUPPLIER NO

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