Individual
DR. LORI BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTOMETRIST
Contact information
Practice address
6446 LBJ FWY, DALLAS, TX 75240-6407
(972) 960-2020
(972) 960-2063
Mailing address
6446 LBJ FWY, DALLAS, TX 75240-6407
(972) 960-2020
(972) 960-2063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1234
LA
152W00000X
Optometrist
Primary
5376T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80502Q
BCBS
TX
Enumeration date
01/18/2006
Last updated
12/03/2007
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