MEDICARE: DR. PATRICIA R BOGAARD 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
1	152W00000X	Optometrist	2163	AZ
2	152W00000X	Optometrist	2001022272	MO
3	152W00000X	Optometrist	622	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	G49B00001	OTHER	MO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255378279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA R BOGAARD O.D.

Provider Business Mailing Address
First Line	:	26520 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1265
Country	:	US
Telephone Number	:	623-537-6000
Fax Number	:	623-806-7210

Provider Business Practice Location Address
First Line	:	15341 W WADDELL RD STE 106
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-5169
Country	:	US
Telephone Number	:	623-544-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/31/2025

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