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General NPI Number Information
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NPI Number | 1154494169
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Entity Type | Individual
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Provider Name | TIMOTHY D. BOOTS O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 1783 S WASHINGTON ST SUITE 111
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City | NAPERVILLE
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State | IL
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Zip | 60565-2462
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Country | US
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Telephone | 630-961-5255
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Fax | 630-961-0335
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Provider Business Mailing Address
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Address Line | 367 DAFFODIL DR
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City | ROMEOVILLE
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State | IL
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Zip | 60446-5127
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Country | US
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Telephone | 815-609-0369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-008982
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002624B
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License Number State | IN
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