Bourne, Ira Robert

Bourne, Ira Robert is an sole proprietor health care provider with primary practice located at 31 St. James Ave Suite 135, Boston MA 02116. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bourne, Ira Robert can be contacted via phone (617) 426-6277.

Contact Information

Primary practice address
31 St. James Ave Suite 135 Boston MA 02116
Phone: (617) 426-6277
Fax: (617) 426-1251
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2241 Massachusetts

Profile Details

NPI number 1356311062
LBN Legal business name Bourne, Ira Robert
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 25th, 2006
Last updated Feb 11th, 2009 - about 17 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 1356311062 NPPES
Massachusetts Other W15325 BC/BS
Massachusetts MEDICAID 0301655 BC/BS
Massachusetts Other AA211 BC/BS
Massachusetts Other MA2241 BC/BS

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