JEFFERY R BOURGERIE (NPI# 1164409348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164409348 |
| Entity Type | Individual |
| Full Name | JEFFERY R BOURGERIE |
| Credential | O.D. |
| Practice Address |
309 E Broadway Ave Medford WI 54451-1835 |
| Mailing Address |
309 E Broadway Ave P.o. Box 547 Medford WI 54451-1835 |
| Practice Telephone | 7157482020 |
| Practice Fax Number | 7157484565 |
| Mailing Telephone | 7157482020 |
| Mailing Fax Number | 7157484565 |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2011-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 2228 | WI | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 37815100 | 05 | |
| WI | SECURITY HEALTH PLAN-MEDF | 21143 | 01 |
| WI | 38581200 | 05 | |
| WI | DEA NUMBER | MB0092661 | 01 |
| WI | RAILROAD MEDICARE-COLBY | 410045063 | 01 |
| WI | NVA-MEDFORD | 10445 | 01 |
| WI | FEDERAL TAX ID-MEDFORD | 39-1229699 | 01 |
| WI | RAILROAD MEDICARE-MEDFORD | 410015253 | 01 |
| WI | DMERC-MEDFORD GROUP | 0474980001 | 01 |
| WI | BLUE CROSS BLUE SHIELD-ME | 391229699015 | 01 |
| WI | SECURITY HEALTH PLAN-COLB | 63857 | 01 |
| WI | DMERC-COLBY GROUP | 1271670001 | 01 |
| WI | 38715300 | 05 | |
| WI | BLUE CROSS BLUE SHIELD-CO | 391967186091 | 01 |
| WI | LICENSE NUMBER | 2228 | 01 |
| WI | FEDERALTAX ID-COLBY | 39-1967186 | 01 |
| Street Address |
309 E BROADWAY AVE |
| City | MEDFORD |
| State | WI |
| Zip Code | 54451-1835 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497732663 | Perry A Arndt | Optometrist | 309 E Broadway Ave, Medford, WI 54451-1835 | 2005-12-28 |
| 1255983185 | Beyond 20-20 Vision Therapy LLC | Optometrist | 309 E Broadway Ave, Medford, WI 54451-1835 | 2019-07-11 |
| 1184119018 | Cord Robert Linville | Optometrist | 309 E Broadway Ave, Medford, WI 54451-1835 | 2018-06-23 |
| 1568874907 | Mathew Bryan Mergenthaler | Optometrist | 309 E Broadway Ave, Medford, WI 54451-1835 | 2014-05-20 |
| 1326486358 | Betsy L Meinel | Optometrist | 309 E Broadway Ave, Medford, WI 54451-1835 | 2013-06-12 |
| 1164492872 | Perry Arndt Od Sc | Optometrist | 309 E Broadway Ave, Medford, WI 54451-1835 | 2006-01-25 |
| 1760469951 | Julie A Thums | Optometrist | 309 E Broadway Ave, Medford, WI 54451-1835 | 2005-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710536321 | Bone & Joint Clinic S.c. | Durable Medical Equipment & Medical Supplies | 724 S. 8th St, Medford, WI 54451 | 2019-09-06 |
| 1215474671 | Heidi Marie Nernberger | Dental Hygienist | 124 S. Main Street, Medford, WI 54451 | 2017-01-24 |
| 1497152656 | Rachel E Nichols | Dental Hygienist | 124 South Main St, Medford, WI 54451 | 2014-12-03 |
| 1811305360 | Amanda Mosse | Social Worker | 10649 W Perkinstown Ave, Medford, WI 54451 | 2014-07-29 |
| 1891081113 | Debra Jeanne Zenner | Nurse Practitioner | 143 South Gibson St., Medford, WI 54451 | 2011-06-24 |
| 1033445036 | Greg George Schoofs II | Ophthalmology | N 4803 Wigwam Ave, Medford, WI 54451 | 2009-10-26 |
| 1558511295 | Aspirus Medford Hospital & Clinics, Inc. | Clinic/Center | 111 S Gibson St, Medford, WI 54451 | 2008-09-30 |
| 1013132430 | Aspirus Medford Hospital & Clinics, Inc. | Pharmacy | 139 S Gibson St, Medford, WI 54451 | 2007-04-13 |
| 1356566707 | Peter G Kiefer | Pharmacist | 139 South Gibson St, Medford, WI 54451 | 2007-04-13 |
| 1851426753 | Steven Todd Dietzman | Specialist/Technologist | 103 South Gibson Street, Medford, WI 54451 | 2007-02-22 |
| Find all providers in zip 54451 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417339359 | Angela Marie Dedionisio | Optometrist | 38 Rossanley Dr, Medford, OR 97501 | 2015-06-28 |
| 1508243239 | Bastian Eyecare Professionals | Optometrist | 12 Revere Pl, Medford, MA 02155-3903 | 2015-05-01 |
| 1700216090 | All Eye Care At Davis, Inc | Optometrist | 63 Station Lndg, Att. Dr Dzenana Idrizovic, Medford, MA 02155-5192 | 2013-11-22 |
| 1518246883 | Yan Lu | Optometrist | 278 Middlesex Ave, Medford, MA 02155-5066 | 2011-08-04 |
| 1821307182 | Diane Marie Shaver | Optometrist | 1600 N Riverside Ave Unit 2027, Medford, OR 97501-4665 | 2010-10-04 |
| 1659491777 | Stephen Allen Barnes | Optometrist | 3639 Crater Lake Hwy, Medford, OR 97504-9259 | 2007-03-30 |
| 1700916251 | Wayne Leroy Knight | Optometrist | 120 Route 70, Medford, NJ 08055-9504 | 2007-03-06 |
| 1477692655 | Kimberly Tischner | Optometrist | 73 S Main Street, Medford, NJ 08055 | 2007-02-05 |
| 1164589230 | Steven Paul Mullins | Optometrist | 1740 Delta Waters Rd, Suite 100, Medford, OR 97504-9175 | 2007-01-02 |
| 1578625612 | Barry Andrew Clegg | Optometrist | 2352 Poplar Dr, Medford, OR 97504-5297 | 2006-12-14 |
| Find all providers in MEDFORD | ||||
Please comment or provide details below to improve the information on JEFFERY R BOURGERIE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.