Provider Demographics
NPI:1295744720
Name:BOUVIER, JOSEPH PETER JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:BOUVIER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:275 BICENTENNIAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1965
Mailing Address - Country:US
Mailing Address - Phone:413-783-3100
Mailing Address - Fax:413-782-7998
Practice Address - Street 1:275 BICENTENNIAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1965
Practice Address - Country:US
Practice Address - Phone:413-783-3100
Practice Address - Fax:413-782-7998
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226532207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226532OtherCONNECTICARE
MA1134436OtherAETNA
MAJ29677OtherBLUE CROSS BLUE SHIELD
MAMB6436OtherBMC HEALTHNET
MA110042142Medicaid
MATUFTSOther494426
MA128529OtherFALLON
MAAA347095OtherHARVARD PILGRIM HEALTH CARE
MAMA3541OtherEYEMED
MA226532OtherMASSACHUSETTS LICENSE
MA226532OtherMASSACHUSETTS LICENSE
MAMA3541OtherEYEMED