Individual
ERIC BRANDON BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1615 SW MAIN BLVD, LAKE CITY, FL 32025-1108
(386) 755-2785
(386) 755-1128
Mailing address
PO BOX 489, LAKE CITY, FL 32056-0489
(386) 755-2785
(386) 755-1128
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OB3178
FL
152W00000X
Optometrist
Primary
OPC3872
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001933700
—
FL
01
—
1180560001
MEDICARE DMERC
—
01
—
25001
BLUE CROSS BLUE SHIELD
FL
01
—
298000
AVMED
FL
05
—
620976900
—
FL
05
—
620976901
—
FL
01
—
7952763
AETNA
FL
01
—
P00188323
RAILROAD MEDICARE
—
Enumeration date
07/01/2006
Last updated
03/21/2011
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