Individual
ELAINE P. BOURDEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618-000960
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119168
ANTHEM BCBS/HEALTHKEEPERS
VA
01
—
119169
ANTHEM BCBS/HEALTHKEEPERS
VA
01
—
119170
ANTHEM BCBS/HEALTHKEEPERS
VA
01
—
119171
ANTHEM BCBS/HEALTHKEEPERS
VA
05
—
3461033-00
—
MD
05
—
3461033-01
—
MD
05
—
3461033-03
—
MD
05
—
3461033-2
—
MD
05
—
9235957
—
VA
05
—
9235973
—
VA
05
—
9235981
—
VA
05
—
9235990
—
VA
Enumeration date
10/18/2006
Last updated
11/04/2016
Update your record
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