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General NPI Number Information
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NPI Number | 1598976581
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Entity Type | Organization
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Legal Business Name | BOUQUET MULLIGAN DEMAIO EYE PROFESSIONALS
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 1676 S MARKET ST
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-2853
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Country | US
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Telephone | 717-272-0581
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Fax |
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Provider Business Mailing Address
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Address Line | 1676 S MARKET ST
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-2853
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Country | US
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Telephone | 717-272-0581
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Fax |
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Authorized Official
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Title or Position | ADMININSTRATOR
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Name | MR. GREGORY M BRACALE
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Credential |
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Telephone | 717-272-0581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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