Provider Demographics
NPI:1710231220
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:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDUC
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:207-284-6651
Mailing Address - Street 1:35 BARRA ROAD
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 1:35 BARRA RD
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:2012-11-06
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty