Provider Demographics
NPI:1871061937
Name:BOURAS, ELAINE
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:BOURAS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:PAPANTONIOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:44 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3508
Practice Address - Country:US
Practice Address - Phone:631-587-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist