Individual
DR. FRED C BOBOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D., P.S.
Contact information
Practice address
403 N EUCLID RD, GRANDVIEW, WA 98930-9407
(509) 882-2650
(509) 882-4225
Mailing address
403 N EUCLID RD, GRANDVIEW, WA 98930-9407
(509) 882-2650
(509) 882-4225
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1634TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010062119
MEDICARE RAILROAD
WA
01
—
0317360001
DME REGION D SUPPLIER NO
WA
05
—
2021554
—
WA
01
—
71549
LABOR AND INDUSTRIES
WA
01
—
911936651
GROUP HEALTH NORTHWEST
WA
01
—
BO4392
BLUE CROSS BLUE SHIELD NO
WA
01
—
G8902905
CHAMPUS ID NO REGION WEST
WA
Enumeration date
01/22/2007
Last updated
04/10/2013
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