1649239112 NPI number — DR. DANIEL LAYNE BOWLING OD

Table of content: DR. DANIEL LAYNE BOWLING OD (NPI 1649239112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649239112 NPI number — DR. DANIEL LAYNE BOWLING OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWLING
Provider First Name:
DANIEL
Provider Middle Name:
LAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWLING
Provider Other First Name:
D
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D., P.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649239112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
122 TAZEWELL STREET
Provider Business Mailing Address City Name:
PEARISBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24134-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-921-3921
Provider Business Mailing Address Fax Number:
540-921-1328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 TAZEWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARISBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24134-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-921-3921
Provider Business Practice Location Address Fax Number:
540-921-1328
Provider Enumeration Date:
03/22/2006

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:  0618000310 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 710D , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4540178 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009204504 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004178 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1461175 . This is a "UNITED MINEWORKERS OF AME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004178 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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