Individual
IRA ROBERT BOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
31 ST. JAMES AVE, SUITE 135, BOSTON, MA 02116
(617) 426-6277
(617) 426-1251
Mailing address
505 TREMONT ST, APT 210, BOSTON, MA 02116-6398
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2241
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0301655
—
MA
01
—
AA211
HARVARD PILGRIM
MA
01
—
MA2241
EYE MED
MA
01
—
W15325
BC/BS
MA
Enumeration date
01/25/2006
Last updated
02/11/2009
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