Provider Demographics
NPI:1699250548
Name:NBHT INDIANA
Entity type:Organization
Organization Name:NBHT INDIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
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:224-730-0650
Mailing Address - Street 1:8319 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8879
Mailing Address - Country:US
Mailing Address - Phone:219-228-1776
Mailing Address - Fax:
Practice Address - Street 1:8319 WICKER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8879
Practice Address - Country:US
Practice Address - Phone:219-228-1776
Practice Address - Fax:219-558-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty