Boutique Optic, LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

067211006 Issued in KY

Legal business name

BOUTIQUE OPTIC, LLC

Practice address

2459 Nicholasville Rd
Lexington, KY 40503-3158

Phone

(859) 278-9486

Fax

(888) 500-3329

NPI assigned

Feb 19, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Jitander S Dudee, MD

Title

President/Owner

Phone

(859) 278-9486

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1952540692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2459 NICHOLASVILLE RD",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033158",
            "telephone_number": "859-278-9486",
            "fax_number": "888-500-3329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2459 NICHOLASVILLE RD",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033158",
            "telephone_number": "859-278-9486",
            "fax_number": "888-500-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUTIQUE OPTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "DUDEE",
        "authorized_official_first_name": "JITANDER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "859-278-9486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "KY",
            "license": "067211006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rose Boudreau
• Bernard Roger Boulanger, M.D.
• Rachel Boulanger
• Keenan Boulnemour
• Walter Branyan Bounds, APRN
• Sandra Bouzaglou, M.D.
• Amber Bow
• Teresa Bowden, CBS
• Edwin Allen Bowe, MD
• Erin Bowe, PHARMD

• Eyewear Supplier in Lexington, KY
• Providers in Lexington, KY by specialty
• Eyewear Supplier in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.