Individual
DR. GREG DAVID BOURDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5001 MONROE ST, JCPENNEY OPTICAL, TOLEDO, OH 43623-3627
(419) 474-4308
Mailing address
1183 TREETOP CT, TOLEDO, OH 43615-6787
(419) 868-8988
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5198 T2102
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2373784
—
OH
Enumeration date
02/15/2007
Last updated
07/08/2007
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