Active NPI
Vassilios Boulougouris, O.D
- Optometrist
- San Juan, PR
National Provider Identifier
1659496347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 277
- Practice address
- 118 Calle Eleonor Roosevelt
San Juan, PR 00918-3105 - Phone
- (787) 765-1915
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 277 | PR | Primary |
Addresses
Primary practice location
118 Calle Eleonor Roosevelt
San Juan, PR 00918-3105
Mailing address
PO Box 364621
San Juan, PR 00936-4621
Phone (787) 365-5584
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 277 | PR | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659496347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 364621",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009364621",
"telephone_number": "787-365-5584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 CALLE ELEONOR ROOSEVELT",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009183105",
"telephone_number": "787-765-1915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULOUGOURIS",
"first_name": "VASSILIOS",
"name_prefix": "Dr.",
"credential": "O.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PR",
"license": "277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.