Provider Demographics
NPI:1386712180
Name:BOURNIAS, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:BOURNIAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3633 WEST LAKE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:847-832-3900
Mailing Address - Fax:847-832-3904
Practice Address - Street 1:233 E ERIE
Practice Address - Street 2:SUITE 614
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-703-9990
Practice Address - Fax:312-703-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL36093343207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633407OtherBLUE CROSS BLUE SHIELD
ILP00164880OtherRAILROAD MEDICARE
ILP00164880OtherRAILROAD MEDICARE
IL01633407OtherBLUE CROSS BLUE SHIELD