NPIMap

Organization Active NPI

NBHT Indiana

Doing business as Vision Boutique

  • Optometrist
  • Saint John, IN
National Provider Identifier
1699250548
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NBHT INDIANA
Doing business as
Vision Boutique
Vision Boutique St John
Practice address
8319 Wicker Ave
Saint John, IN 46373-8879
Phone
(219) 228-1776
Fax
(219) 558-0672
NPI assigned
Sep 26, 2018
Last updated
Sep 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Neil Alan Boldus, ODNPI 1992823462
Title
Managing Member
Phone
(224) 730-0650

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

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 2

  • Vision Boutique Doing business as
  • Vision Boutique St John Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

9410 Calumet Ave
Ste 103A
Munster, IN 46321
Phone (219) 728-4452

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1699250548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8319 WICKER AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738879",
            "telephone_number": "219-228-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8319 WICKER AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738879",
            "telephone_number": "219-228-1776",
            "fax_number": "219-558-0672"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3929 N Western Ave Ste 1S",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606183751",
            "country_code": "US",
            "telephone_number": "773-828-5873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NBHT INDIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-26",
        "last_updated": "2023-09-06",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "BOLDUS",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "224-730-0650",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Boutique",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vision Boutique St John",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint John, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.