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General NPI Number Information
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NPI Number | 1811376205
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Entity Type | Individual
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Provider Name | DORIS BOUDAIE OD
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Gender | Female
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 8500 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-6201
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Country | US
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Telephone | 310-360-3937
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Fax | 310-360-3928
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Provider Business Mailing Address
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Address Line | 260 S BEVERLY DR STE 333
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3810
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Country | US
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Telephone | 310-360-3937
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Fax | 310-360-3928
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 10992
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License Number State | CA
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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 | 10992T
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License Number State | CA
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