NPIMap

Organization Active NPI

Bouquet Mulligan Eye Professionals LTD

  • Eyewear Supplier
  • Elizabethtown, PA
National Provider Identifier
1780011999
Registry record updated Oct 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
BOUQUET MULLIGAN EYE PROFESSIONALS LTD
Practice address
600 Free Mason Drive
Elizabethtown, PA 17022
Phone
(717) 272-0581
Fax
(717) 274-5889
NPI assigned
Oct 2, 2013
Last updated
Oct 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2013

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

Authorized official

Name
Mr. Gregory M Bracale
Title
Administrator
Phone
(717) 272-0581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X PA Primary

Addresses

Primary practice location

600 Free Mason Drive
Elizabethtown, PA 17022

Mailing address

233 W Penn Ave
Cleona, PA 17042-3230
Phone (717) 272-0581

Other identifiers 1

IdentifierTypeStateIssuer
4367030002OtherPAPTAN

National Provider Directory

National Provider Directory
Tax ID family
Bouquet Mulligan Eye Professionals LTD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1780011999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 W PENN AVE",
            "city": "CLEONA",
            "state": "PA",
            "postal_code": "170423230",
            "telephone_number": "717-272-0581",
            "fax_number": "717-274-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 FREE MASON DRIVE",
            "city": "ELIZABETHTOWN",
            "state": "PA",
            "postal_code": "17022",
            "telephone_number": "717-272-0581",
            "fax_number": "717-274-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUQUET MULLIGAN EYE PROFESSIONALS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "BRACALE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "717-272-0581",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "4367030002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.