NPI 1003650904

Lydia Bouman

Practitioner Optometrist Medford, OR

Practice location

Address: 1600 N Riverside Ave, Medford, OR 97501-4652
Phone: (458) 658-5295
Mailing address: 3420 S Cottage Grove Ave APT 801, Chicago, IL 60616-5112

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence AT4721 (OR)

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Registry record

NPI: 1003650904
Entity type: Individual
Sex (as registered): Female
NPI issued: 24 Jun 2024
Record last updated: 24 Jun 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.