Bourgeois, Amanda J.

Bourgeois, Amanda J. is an individual health care provider with primary practice located at 807 Childrens Way , Jacksonville FL 32207-8426. She recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Pediatrics. Eye and Vision Services Providers / Pediatrics is her primary health care specialty. Bourgeois, Amanda J. can be contacted via phone (904) 390-3705.

Contact Information

Primary practice address
807 Childrens Way Jacksonville FL 32207-8426
Phone: (904) 390-3705
Fax: (904) 390-3502
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OPC3215 Florida
Eye and Vision Services Providers / Pediatrics 152WP0200X OPC3215 Florida

Profile Details

NPI number 1063423580
LBN Legal business name Bourgeois, Amanda J.
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2006
Last updated Sep 7th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063423580 NPPES
Florida MEDICAID 620608500
Florida MEDICAID 000901117A

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