Individual
CHARLES BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S FIRST AVE, (17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181), MAYWOOD, IL 60153
(630) 627-7399
(630) 627-7079
Mailing address
2160 S FIRST AVE, (17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181), MAYWOOD, IL 60153
(630) 627-7399
(630) 627-7079
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
36080233
IL
207WX0120X
Cornea and External Diseases Specialist Physician
Primary
036080233
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36080233
—
IL
Enumeration date
02/24/2006
Last updated
10/18/2021
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