Organization
BOUQUET MULLIGAN DEMAIO EYE PROFESSIONALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY M BRACALE (ADMININSTRATOR)
(717) 272-0581
Entity
Organization
Contact information
Practice address
600 FREE MASON DRIVE, ELIZABETHTOWN, PA 17022
(717) 272-0581
(717) 274-5889
Mailing address
233 W PENN AVE, CLEONA, PA 17042-3230
(717) 272-0581
(717) 274-5889
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000209
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BO867272
PTAN
PA
Enumeration date
10/02/2013
Last updated
10/02/2013
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