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General NPI Number Information
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NPI Number | 1871061937
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Entity Type | Individual
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Provider Name | DR. ELAINE BOURAS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 40 E MAIN ST
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City | BABYLON
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State | NY
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Zip | 11702-3508
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Country | US
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Telephone | 631-587-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 44 PINE ST
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City | HICKSVILLE
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State | NY
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Zip | 11801-3236
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Country | US
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Telephone |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 008902
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License Number State | NY
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