Provider Demographics
NPI:1528248044
Name:BUKOWSKI, TED F (OD)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:F
Last Name:BUKOWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766
Mailing Address - Country:US
Mailing Address - Phone:508-285-2015
Mailing Address - Fax:508-285-5094
Practice Address - Street 1:140 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766
Practice Address - Country:US
Practice Address - Phone:508-285-2015
Practice Address - Fax:508-285-5094
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOP3840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
135655OtherCOMANAGEMENT VISION
2200344OtherUNITED HEALTH CARE
22420OtherCVC MANAGEMENT
409293OtherBCBS BLUE CHIP OF RI
MA0392375Medicaid
W15979OtherBCBS OF MA
34141OtherDAVIS VISION
W20277OtherBCBS OF MA GROUP
76434OtherHEALTHCARE BCBS OF RI
MA3840OtherIMED
152099OtherHARVARD PILGRIM HEALTH CA
1984094001OtherCIGNA
814302OtherAETNA US HEALTH CARE
MA3840OtherIMED