Provider Demographics
NPI:1942327408
Name:BOONE OPTICAL SERVICES, INC.
Entity Type:Organization
Organization Name:BOONE OPTICAL SERVICES, INC.
Other - Org Name:GREEN VALLEY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-648-3121
Mailing Address - Street 1:1150 S CALLE DE LAS CASITAS STE 120
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2061
Mailing Address - Country:US
Mailing Address - Phone:520-648-3121
Mailing Address - Fax:520-399-1631
Practice Address - Street 1:1150 S CALLE DE LAS CASITAS STE 120
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-2061
Practice Address - Country:US
Practice Address - Phone:520-648-3121
Practice Address - Fax:520-399-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0728160001Medicare NSC