Healthcare Provider Details

I. General information

NPI: 1659506400
Provider Name (Legal Business Name): BOURN AND ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 FOUR SEASONS SHOPPING CTR STE 110
CHESTERFIELD MO
63017-3173
US

IV. Provider business mailing address

64 NAVAJO DR
SPRINGFIELD IL
62711-6084
US

V. Phone/Fax

Practice location:
  • Phone: 217-303-8600
  • Fax:
Mailing address:
  • Phone: 217-741-2315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008999
License Number StateIL

VIII. Authorized Official

Name: MRS. TONYA K BOURN
Title or Position: PRESIDENT
Credential: OD
Phone: 217-303-8600