Healthcare Provider Details

I. General information

NPI: 1679521603
Provider Name (Legal Business Name): DANIEL E BOONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 VILLAGE CENTER ST
NIXA MO
65714-7824
US

IV. Provider business mailing address

107 VILLAGE CENTER ST
NIXA MO
65714-7824
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-0000
  • Fax: 417-725-0002
Mailing address:
  • Phone: 417-725-0000
  • Fax: 417-725-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberT03007
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03007
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: