Individual
DR. WILLIAM BRUCE BOURLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
701 FRONT ST, EVANSTON, WY 82930-3522
(307) 789-8820
(307) 789-8823
Mailing address
701 FRONT ST, EVANSTON, WY 82930-3522
(307) 789-8820
(307) 789-8823
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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