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NPI Code Detail

MEDICARE: DR. RAYMOND D BOONE O.D.

MEDICARE: DR. RAYMOND D BOONE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2395TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113399OTHERTXSPECTERA
200E62NOTHERTXBLUE CROSS BLUE SHIELD
347696OTHERTXDAVIS VISION
4920251OTHERTXBLOCK VISION
5128051OTHERTXCHIPS
6550180OTHERTXNATIONAL VISION ADMIN.

General Provider Information

NPI Number : 1114028289
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAYMOND D BOONE O.D.
Provider Business Mailing Address
First Line : 1311 S JACKSON ST
Second Line : SUITE A
City : JACKSONVILLE
State : TX
Zip : 75766-3050
Country : US
Telephone Number : 903-586-1514
Fax Number : 903-586-1515
Provider Business Practice Location Address
First Line : 1311 S JACKSON ST
Second Line : SUITE A
City : JACKSONVILLE
State : TX
Zip : 75766-3050
Country : US
Telephone Number : 903-586-1514
Fax Number : 903-586-1515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/08/2007

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