Provider Demographics
NPI:1447287503
Name:BOGGS, MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BOGGS
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 1:3085 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2916
Mailing Address - Country:US
Mailing Address - Phone:805-648-3085
Mailing Address - Fax:805-648-7027
Practice Address - Street 1:3085 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2916
Practice Address - Country:US
Practice Address - Phone:805-648-3085
Practice Address - Fax:805-648-7027
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8427TOtherCHAMPUS
CA205153800OtherUS DEPT. OF LABOR
CA8427TOtherBLUE SHIELD
CAWOP84270OtherDMERC
CA8427TOtherBLUE SHIELD
WOP84270Medicare ID - Type Unspecified