Provider Demographics
NPI:1588993778
Name:HTNB LLC
Entity type:Organization
Organization Name:HTNB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOLDUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-432-0080
Mailing Address - Street 1:14 S PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2628
Mailing Address - Country:US
Mailing Address - Phone:224-730-0650
Mailing Address - Fax:312-432-0586
Practice Address - Street 1:14 S PEORIA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2628
Practice Address - Country:US
Practice Address - Phone:224-730-0650
Practice Address - Fax:312-432-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty