Healthcare Provider Details

I. General information

NPI: 1164503934
Provider Name (Legal Business Name): BOUQUET MULLIGAN EYE PROFESSIONALS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W PENN AVE
CLEONA PA
17042-3230
US

IV. Provider business mailing address

233 W PENN AVE
CLEONA PA
17042-3230
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-0581
  • Fax: 717-274-5889
Mailing address:
  • Phone: 717-272-0581
  • Fax: 717-274-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES P BOUQUET
Title or Position: OWNER
Credential: O.D.
Phone: 717-272-0581