LYDIA BOUMAN
NPI 1003650904
Optometrist in Medford, OR

Q: What is Lydia Bouman's NPI number?

The NPI number for Lydia Bouman is 1003650904. It was assigned to this individual provider in the NPPES registry on June 24, 2024.

Q: What is Lydia Bouman's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Lydia Bouman was last updated on June 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 24, 2024PECOS Enrolled

1600 N RIVERSIDE AVE, MEDFORD, OR 97501(458) 658-5295 Get Directions Write a Review

NPPES record last updated: June 24, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Lydia Bouman NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LYDIA BOUMAN (NPI 1003650904) is an individual optometrist in Medford, Oregon, licensed in Oregon (AT4721) and active in the NPI registry since June 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1003650904

Entity TypeIndividualFemale

Primary Taxonomy152W00000X

Provider Legal NameLYDIA BOUMAN

Location Address1600 N RIVERSIDE AVEMedford, OR 97501-4652

Mailing Address3420 S Cottage Grove Ave Apt 801Chicago, IL 60616-5112

Phone(458) 658-5295

Sole ProprietorNo

Enumeration DateJune 24, 2024

NPPES CertifiedJune 24, 2024

✔ NPI 1003650904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in OR · AT4721

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

1600 N RIVERSIDE AVE, Medford, OR 97501

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross Blue Shield of Wyoming, BridgeSpan Health Company and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lydia Bouman is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Lydia Bouman reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Maisha Optical LLC

0.4 mi

Optometrist

1251 E MCANDREWS RD STE 100
Medford, OR 97504

Reassigned Medicare billing, Oregon enrollment
4 clinicians in this Medicare group

NPI 1013603380 (808) 264-4810

Pacific Eye Group, PC

145 mi

Optometrist

63455 N HWY 97 STE 75
Bend, OR 97703

Reassigned Medicare billing, Oregon enrollment
20 clinicians in this Medicare group

NPI 1831656925 (541) 389-5207

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97501 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$126.25 typical visit price

range $54.96 – $166.64

Typical copayment $31.56 (range $13.74 – $41.66)

Most-billed visit code 99204

Established Patient

$68.64 typical visit price

range $17.68 – $136.19

Typical copayment $17.16 (range $4.42 – $34.04)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEPHEN T GILLESPIE D.D.S

Dentist (General Practice)

1600 N RIVERSIDE AVE, 1164
MEDFORD, OR 97501

Jackson County (541) 776-6996

PACIFIC EYE GROUP, PC

Optometrist

1600 N RIVERSIDE AVE
MEDFORD, OR 97501

Jackson County (541) 779-9851

MODERN DENTAL CARE, P.C.

Dentist (General Practice)

1600 N RIVERSIDE AVE, 1164
MEDFORD, OR 97501

Jackson County (541) 776-6996

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lydia Bouman's NPI number?

The NPI number for Lydia Bouman is 1003650904. It was assigned to this individual provider in the NPPES registry on June 24, 2024.

Where is Lydia Bouman located?

Lydia Bouman practices at 1600 N Riverside Ave, Medford, OR 97501. The listed phone number is (458) 658-5295.

What is Lydia Bouman's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Lydia Bouman enrolled in Medicare?

Yes. Lydia Bouman is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Lydia Bouman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lydia Bouman reassigns Medicare benefits to 2 organizations: Maisha Optical LLC (Medford, OR) and Pacific Eye Group, PC (Bend, OR). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Lydia Bouman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Lydia Bouman accept?

Health plans from Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, BridgeSpan Health Company, Moda Health Plan, Inc. and PacificSource Health Plans and 2 other insurers list Lydia Bouman as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lydia Bouman was last updated on June 24, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.