Healthcare Provider Details

I. General information

NPI: 1962943167
Provider Name (Legal Business Name): JOSEPH DANIEL BOGAARD MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22903-3363
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5485
  • Fax: 434-244-9436
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7652-851
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01090167A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101271485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: