1528248044 NPI number — TED F BUKOWSKI OD

Table of content: TED F BUKOWSKI OD (NPI 1528248044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528248044 NPI number — TED F BUKOWSKI OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUKOWSKI
Provider First Name:
TED
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528248044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 EAST MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-285-2015
Provider Business Mailing Address Fax Number:
508-285-5094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 EAST MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-285-2015
Provider Business Practice Location Address Fax Number:
508-285-5094
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OP3840 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 135655 . This is a "COMANAGEMENT VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2200344 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22420 . This is a "CVC MANAGEMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 409293 . This is a "BCBS BLUE CHIP OF RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0392375 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W15979 . This is a "BCBS OF MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34141 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: W20277 . This is a "BCBS OF MA GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76434 . This is a "HEALTHCARE BCBS OF RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA3840 . This is a "IMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 152099 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1984094001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 814302 . This is a "AETNA US HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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