Organization
BEDFORD EYECARE, P.A.
Active
Other names
First Eye Care Bedford
Organization subpart
No
Provider details
NPI number
Authorized official
LORI MARIE BOURQUE O.D. (OWNER)
(972) 960-2020
Entity
Organization
Contact information
Practice address
2400 AIRPORT FWY STE 140, BEDFORD, TX 76022-6098
(817) 284-2964
(817) 283-2760
Mailing address
2400 AIRPORT FWY STE 140, BEDFORD, TX 76022-6098
(972) 960-2020
(972) 960-2063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5376TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8L4564
INDIVIDUAL PTAN
TX
Enumeration date
07/10/2006
Last updated
06/21/2011
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