1922159169 NPI number — DR. CARL DAVID BOLLINGER O.D.

Table of content: EDITH JENKINS (NPI 1982142527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922159169 NPI number — DR. CARL DAVID BOLLINGER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLLINGER
Provider First Name:
CARL
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922159169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEMMONS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27012-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-766-7373
Provider Business Mailing Address Fax Number:
336-766-7382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 STADIUM DR
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
CLEMMONS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27012-8766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-766-7373
Provider Business Practice Location Address Fax Number:
336-766-7382
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1020 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 561282758 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 917812 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13283 . This is a "SPECTERA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0952390001 . This is a "PALMETTO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 09114 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com