Provider Demographics
NPI:1699727032
Name:BOSSE, JAMES CLYDE (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLYDE
Last Name:BOSSE
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 1:29 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9679
Mailing Address - Country:US
Mailing Address - Phone:719-275-3840
Mailing Address - Fax:
Practice Address - Street 1:2776 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4010
Practice Address - Country:US
Practice Address - Phone:719-275-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08008948Medicaid
CO08008948Medicaid
COT60760Medicare UPIN