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Individual
DR. MICHAEL PAUL BOURGOIN
Active
Individual
DR. MICHAEL PAUL BOURGOIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9870T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548472921
GROUP NPI
CA
01
—
9870T
CA OPTOMETRY LICENSE #
CA
01
—
WOP9870I
PPIN
CA
Enumeration date
08/29/2006
Last updated
11/02/2007
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