Provider Demographics
NPI:1811376205
Name:BOUDAIE, DORIS (OD)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:BOUDAIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 S BEVERLY DR STE 333
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3810
Mailing Address - Country:US
Mailing Address - Phone:310-360-3937
Mailing Address - Fax:310-360-3928
Practice Address - Street 1:8500 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6201
Practice Address - Country:US
Practice Address - Phone:310-360-3937
Practice Address - Fax:310-360-3928
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10992152WC0802X
CA10992T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist