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Contact Information

FRED C BOBOTH, O.D., P.S.
403 N EUCLID RD
GRANDVIEW, WA98930-9407
 Phone: 509-882-2650
 Fax: 509-882-4225
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for FRED C BOBOTH · (Male)

NPI # 1194879700
Status Active
Credentials O.D., P.S.
Entity Individual
Enumeration date 01/22/2007
Last updated 04/10/2013 - About 13 years ago
Sole proprietor 1 Yes
Identifiers
  • WA License # 1634TX
  • WA Medicaid 2021554
  • WA Other BO4392 BLUE CROSS BLUE SHIELD NO
  • WA Other G8902905 CHAMPUS ID NO REGION WEST
  • WA Other 0317360001 DME REGION D SUPPLIER NO
  • WA Other 911936651 GROUP HEALTH NORTHWEST
  • WA Other 71549 LABOR AND INDUSTRIES
  • WA Other 010062119 MEDICARE RAILROAD
  • WA Other 911936651 PREMERA BLUE CROSS
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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