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General NPI Number Information
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NPI Number | 1669648374
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Entity Type | Individual
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Provider Name | SAMEH ABDOU BOULES OPTOMETRIST - O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 3732 S KINGSHIGHWAY BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63109-1800
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Country | US
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Telephone | 314-446-1134
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Fax | 314-446-1136
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Provider Business Mailing Address
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Address Line | 211 E BROADWAY
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City | ALTON
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State | IL
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Zip | 62002-6220
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Country | US
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Telephone | 618-462-9818
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Fax | 800-432-6004
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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 | TUV007255
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License Number State | NY
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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 | 046010527
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2011020049
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007255-1
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License Number State | NY
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