Bourse Optical Boutique, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

PAOEG001128 Issued in PA

Legal business name

BOURSE OPTICAL BOUTIQUE, INC.

Practice address

2275 Swallow Hill Rd
Building 700
Pittsburgh, PA 15220-1656

Phone

(412) 489-6726

Fax

(412) 489-6732

NPI assigned

Jun 13, 2007

Last updated

Mar 4, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John K. Gregory, O.D.NPI 1366525347

Title

President

Phone

(412) 489-6726

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Karl Gregory, O.D.

  • Optometrist
  • Pittsburgh, PA
  • NPI 1366525347
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393891200000",
    "number": "1477757433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 SWALLOW HILL RD",
            "address_2": "BUILDING 700",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152201656",
            "telephone_number": "412-489-6726",
            "fax_number": "412-489-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 SWALLOW HILL RD",
            "address_2": "BUILDING 700",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152201656",
            "telephone_number": "412-489-6726",
            "fax_number": "412-489-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOURSE OPTICAL BOUTIQUE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2014-03-04",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "412-489-6726",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "PAOEG001128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Kallenborn Bourdius, CGC
• Susan Bourdon, RN, MSN, CS
• Richard Olivier Bourguillon, MD
• Debra Anne Bourne, MD
• Donald Bourne, MD, PHD, MPH
• Alexis Bousamra, M.D.
• John Paul Boustead, D.C.
• John Howard Bout, MA, MS, LBS
• Kassandra Bout
• Albert Bouwer Monroy, DO

• Optometrist in Pittsburgh, PA
• Providers in Pittsburgh, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.