Organization
BOUTIQUE OPTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JITANDER S DUDEE MD (PRESIDENT/OWNER)
(859) 278-9486
Entity
Organization
Contact information
Practice address
2459 NICHOLASVILLE RD, LEXINGTON, KY 40503-3158
(859) 278-9486
(888) 500-3329
Mailing address
2459 NICHOLASVILLE RD, LEXINGTON, KY 40503-3158
(859) 278-9486
(888) 500-3329
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
067211006
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
KY
Enumeration date
02/19/2009
Last updated
03/23/2011
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