Organization
BOUQUET MULLIGAN EYE PROFESSIONALS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY M BRACALE (ADMINISTRATOR)
(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
332H00000X
Eyewear Supplier
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4367030002
PTAN
PA
Enumeration date
10/02/2013
Last updated
10/02/2013
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