Provider Demographics
NPI:1114028289
Name:BOONE, RAYMOND D (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:D
Last Name:BOONE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1311 S JACKSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-3050
Mailing Address - Country:US
Mailing Address - Phone:903-586-1514
Mailing Address - Fax:903-586-1515
Practice Address - Street 1:1311 S JACKSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-3050
Practice Address - Country:US
Practice Address - Phone:903-586-1514
Practice Address - Fax:903-586-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2395TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13399OtherSPECTERA
TX00E62NOtherBLUE CROSS BLUE SHIELD
TX47696OtherDAVIS VISION
TX920251OtherBLOCK VISION
TX128051OtherCHIPS
TX550180OtherNATIONAL VISION ADMIN.
TX128051OtherCHIPS
TX47696OtherDAVIS VISION