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General NPI Number Information
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NPI Number | 1699250548
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Entity Type | Organization
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Legal Business Name | NBHT INDIANA
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 8319 WICKER AVE
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City | SAINT JOHN
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State | IN
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Zip | 46373-8879
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Country | US
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Telephone | 219-228-1776
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Fax | 219-558-0672
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Provider Business Mailing Address
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Address Line | 8319 WICKER AVE
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City | SAINT JOHN
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State | IN
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Zip | 46373-8879
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Country | US
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Telephone | 219-228-1776
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. NEIL ALAN BOLDUS
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Credential | OD
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Telephone | 224-730-0650
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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 |
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