Bourgerie, Jeffery R

Bourgerie, Jeffery R is an individual health care provider with primary practice located at 309 E Broadway Ave , Medford WI 54451-1835. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bourgerie, Jeffery R can be contacted via phone (715) 748-2020.

Contact Information

Primary practice address
309 E Broadway Ave Medford WI 54451-1835
Phone: (715) 748-2020
Fax: (715) 748-4565
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2228 Wisconsin

Profile Details

NPI number 1164409348
LBN Legal business name Bourgerie, Jeffery R
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2005
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164409348 NPPES
Wisconsin MEDICAID 38715300
Wisconsin MEDICAID 37815100
Wisconsin Other 39-1229699
Wisconsin Other 391229699015
Wisconsin Other 0474980001
Wisconsin Other 10445
Wisconsin Other 410045063
Wisconsin Other 1271670001
Wisconsin Other 21143
Wisconsin Other 2228
Wisconsin Other 39-1967186
Wisconsin MEDICAID 38581200
Wisconsin Other 391967186091
Wisconsin Other 410015253
Wisconsin Other 63857

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