Provider Demographics
NPI:1154494169
Name:BOOTS, TIMOTHY D (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:BOOTS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 DAFFODIL DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5127
Mailing Address - Country:US
Mailing Address - Phone:815-609-0369
Mailing Address - Fax:
Practice Address - Street 1:1783 S WASHINGTON ST
Practice Address - Street 2:SUITE 111
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2462
Practice Address - Country:US
Practice Address - Phone:630-961-5255
Practice Address - Fax:630-961-0335
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008982152W00000X
IN18002624B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8982OtherEYEMED PROVIDER NUMBER
IL09932239OtherBCBS PROVIDER NUMBER
IL25285OtherSPECTERA PROVIDER NUMBER
IL9355873OtherPHCS PROVIDER ID NUMBER
IL36-4167298OtherVSP PROVIDER NUMBER
IL09932239OtherBCBS PROVIDER NUMBER
IL36-4167298OtherVSP PROVIDER NUMBER