Provider Demographics
NPI:1255378279
Name:BOGAARD, PATRICIA R (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:R
Last Name:BOGAARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7374 W HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7241
Mailing Address - Country:US
Mailing Address - Phone:660-641-5398
Mailing Address - Fax:
Practice Address - Street 1:15341 W WADDELL RD STE 106
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5169
Practice Address - Country:US
Practice Address - Phone:623-544-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2163152W00000X
SD622152W00000X
MO2001022272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9203570Medicaid
MOG49B00001OtherMEDICARE PTAN
U89724Medicare UPIN
SD101136Medicare PIN
SD9203570Medicaid