Greg David Bourdon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5198 T2102 Issued in OH

Practice address

5001 Monroe St
Jcpenney Optical
Toledo, OH 43623-3627

Phone

(419) 474-4308

NPI assigned

Feb 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750424073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1183 TREETOP CT",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436156787",
            "telephone_number": "419-868-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 MONROE ST",
            "address_2": "JCPENNEY OPTICAL",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436233627",
            "telephone_number": "419-474-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDON",
        "first_name": "GREG",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5198 T2102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2373784",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea N Bouie
• Peter Boules, DO
• Mesa Bouni
• Madison Bour
• Nabeel M Bourawi, D.C.
• Camry C Bourn-Anderson
• Mounir Boutros, MD
• Devon Bouyer
• Jeffrey Boward, MD
• Angela Bowden, CNP

• Optometrist in Toledo, OH
• Providers in Toledo, OH by specialty
• Optometrist in Ohio

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.