Individual
MELISSA DAWN BOURLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1001 MAIN ST STE 1, DYER, IN 46311-1200
(219) 322-7800
Mailing address
115 IVY LN, DYER, IN 46311-1348
(219) 381-7208
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004066A
IN
Other
Enumeration date
08/15/2017
Last updated
03/17/2018
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