MEDICARE: THOMAS E BOULDEN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2618	WI

General Provider Information

NPI Number	:	1427052182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS E BOULDEN OD

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54702-1510
Country	:	US
Telephone Number	:	608-372-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 BUTTS AVE
Second Line	:
City	:	TOMAH
State	:	WI
Zip	:	54660-1412
Country	:	US
Telephone Number	:	608-372-5951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/16/2020

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Directions to “ THOMAS E BOULDEN OD” Practice Location

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