Provider Demographics
NPI:1609434604
Name:BOONE, DANIEL AUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:AUSTIN
Last Name:BOONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 VILLAGE CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7824
Mailing Address - Country:US
Mailing Address - Phone:417-725-0000
Mailing Address - Fax:417-725-0001
Practice Address - Street 1:107 VILLAGE CENTER ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7824
Practice Address - Country:US
Practice Address - Phone:417-725-0000
Practice Address - Fax:417-725-0001
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019016836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist