Provider Demographics
NPI:1669750246
Name:BOALDIN EYE CARE
Entity type:Organization
Organization Name:BOALDIN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOALDIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-993-0575
Mailing Address - Street 1:353 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4751
Mailing Address - Country:US
Mailing Address - Phone:405-767-2020
Mailing Address - Fax:405-767-2022
Practice Address - Street 1:1901 NW EXPRESSWAY
Practice Address - Street 2:SUITE #2058
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1607
Practice Address - Country:US
Practice Address - Phone:405-767-2020
Practice Address - Fax:405-767-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200344100AMedicaid