Individual
DR. WILLIAM BRUCE BOURLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
203T
WY
152W00000X
Optometrist
238
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102083800
—
WY
01
—
4437740001
CIGNA/MEDICARE
—
01
—
830336991
AETNA
—
Enumeration date
08/09/2005
Last updated
09/15/2010
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