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General NPI Number Information
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NPI Number | 1548390495
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Entity Type | Individual
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Provider Name | RALPH BOURJOLLY O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 1341 S POWERLINE RD
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4313
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Country | US
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Telephone | 954-972-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 135 WESTON RD # 248
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City | WESTON
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State | FL
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Zip | 33326-1111
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Country | US
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Telephone | 561-212-5107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2667
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 2667
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2667
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License Number State | FL
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