Provider Demographics
NPI:1346425741
Name:ROBERT J. BOLDUC, OPTOMETRIST, P.A.
Entity Type:Organization
Organization Name:ROBERT J. BOLDUC, OPTOMETRIST, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-284-6651
Mailing Address - Street 1:311 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3127
Mailing Address - Country:US
Mailing Address - Phone:207-284-6651
Mailing Address - Fax:207-286-9579
Practice Address - Street 1:311 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3127
Practice Address - Country:US
Practice Address - Phone:207-284-6651
Practice Address - Fax:207-286-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME660T332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0334240001Medicare NSC