Provider Demographics
NPI:1104921113
Name:BOGAARD AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:BOGAARD AND ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BOGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-880-1453
Mailing Address - Street 1:7035 TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:SD
Mailing Address - Zip Code:57718-9819
Mailing Address - Country:US
Mailing Address - Phone:402-880-1453
Mailing Address - Fax:
Practice Address - Street 1:1751 MADISON AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5246
Practice Address - Country:US
Practice Address - Phone:712-325-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA 2249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10900Medicare ID - Type Unspecified