NBHT Indiana
Organization Active NPI Optometrist · Saint John, IN
NPI 1699250548 · NPPES record last updated Sep 6, 2023
Key facts
- NPI
- 1699250548
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- NBHT INDIANA
- Practice address
- 8319 Wicker Ave
Saint John, IN 46373-8879 - Phone
- (219) 228-1776
- Fax
- (219) 558-0672
- NPI assigned
- Sep 26, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Neil Alan Boldus, OD
- Title
- Managing Member
- Phone
- (224) 730-0650
Practitioners 7
-
Helen Tzanetakos, OD
-
Neil Alan Boldus, O.D.
-
Amanda Hok Lay, OD
-
Diana Li, OD
-
Namrata Shah, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN, IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221220002042 | IN | Part B Supplier - Clinic/Group Practice | 0547639221 |
Receives reassigned benefits from 3 practitioners Practice locations: Munster, IN; Saint John, IN |
| O20240207000694 | IL | Part B Supplier - Clinic/Group Practice | 0547639221 |
Receives reassigned benefits from 5 practitioners Practice locations: Chicago, IL |
National Provider Directory
Locations
3929 N Western Ave
Ste 1S
Chicago, IL 60618
Phone (773) 828-5873
8319 Wicker Ave
Saint John, IN 46373
Phone (219) 228-1776
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
8319 Wicker Ave
Saint John, IN 46373-8879
Mailing address
8319 Wicker Ave
Saint John, IN 46373-8879
Phone (219) 228-1776
Other practice location 1
3929 N Western Ave Ste 1S
Chicago, IL 60618-3751
Phone (773) 828-5873
Other names
- Vision Boutique
- Vision Boutique St John
Other providers in Saint John, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.