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General NPI Number Information
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NPI Number | 1689761900
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Entity Type | Individual
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Provider Name | NOKHRAM BOODHOO O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4351 16TH ST
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City | MOLINE
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State | IL
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Zip | 61265-7009
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Country | US
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Telephone | 309-797-5900
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Fax | 309-797-4275
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Provider Business Mailing Address
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Address Line | 4233 8TH 1/2 ST
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City | EAST MOLINE
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State | IL
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Zip | 61244-4170
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Country | US
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Telephone | 309-796-0597
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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 |
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License Number State | IL
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