Healthcare Provider Details

I. General information

NPI: 1588656151
Provider Name (Legal Business Name): CARL ALLEN BOECK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9621 MISSION GORGE RD 106
SANTEE CA
92071-3802
US

IV. Provider business mailing address

9444 DOHENY RD #50
SANTEE CA
92071-2507
US

V. Phone/Fax

Practice location:
  • Phone: 619-449-2000
  • Fax: 619-449-8303
Mailing address:
  • Phone: 619-449-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT6620T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: