Most Relevant Information
Provider Data
| NPI Number: | 1003650904 |
| Provider Name: | LYDIA BOUMAN |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | AT4721 |
Most Important Dates
| Enumeration Date: | 06/24/2024 |
| Last Updated: | 06/24/2024 |
Provider Practice Location
1600 N RIVERSIDE AVE
MEDFORD
OR
975014652
Practice Location Phone/Fax
| Phone: | 4586585295 |
| Fax: |
Provider Mailing Location
3420 S COTTAGE GROVE AVE APT 801
CHICAGO
IL
606165112
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |