Provider Demographics
NPI:1922257864
Name:BOLDAN, JOHN D JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:BOLDAN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1750 S BROADWAY ST
Mailing Address - Street 2:STE 2020
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4902
Mailing Address - Country:US
Mailing Address - Phone:903-438-1000
Mailing Address - Fax:
Practice Address - Street 1:1606 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5614
Practice Address - Country:US
Practice Address - Phone:903-572-4000
Practice Address - Fax:903-575-0769
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5488T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist