Provider Demographics
NPI:1801880745
Name:BOLDREY, EDWIN E (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:E
Last Name:BOLDREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2485 HOSPITAL DR
Mailing Address - Street 2:ORCHARD PAVILION STE 200
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4101
Mailing Address - Country:US
Mailing Address - Phone:650-988-7480
Mailing Address - Fax:650-988-7482
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:ORCHARD PAVILION STE 200
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-988-7480
Practice Address - Fax:650-988-7482
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG17069207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180014997OtherMEDICARE RAILROAD
CA00G170692Medicaid
CABY034YMedicare PIN
CA180014997OtherMEDICARE RAILROAD
CABY034XMedicare PIN
CA00G170692Medicaid