Provider Demographics
NPI:1922027846
Name:BERNARD L. MCGOWAN, M.D., INC.
Entity Type:Organization
Organization Name:BERNARD L. MCGOWAN, M.D., INC.
Other - Org Name:MCGOWAN EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-872-4590
Mailing Address - Street 1:297 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6337
Mailing Address - Country:US
Mailing Address - Phone:508-872-4590
Mailing Address - Fax:508-872-0038
Practice Address - Street 1:297 UNION AVE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6337
Practice Address - Country:US
Practice Address - Phone:508-872-4590
Practice Address - Fax:508-872-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28621261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9745963Medicaid
MAM11561OtherBLUE CROSS BLUE SHIELD
MAM11561Medicare ID - Type Unspecified