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General NPI Number Information
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NPI Number | 1255378279
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Entity Type | Individual
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Provider Name | PATRICIA R BOGAARD O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 15341 W WADDELL RD STE 106
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City | SURPRISE
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State | AZ
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Zip | 85379-5169
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Country | US
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Telephone | 623-544-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 26520 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1265
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Country | US
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Telephone | 623-537-6000
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Fax | 623-806-7210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2163
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2001022272
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 622
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License Number State | SD
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