MEDICARE: RACHAEL NICOLE BOWLING LDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	1101003191	VA

General Provider Information

NPI Number	:	1215332432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL NICOLE BOWLING LDO

Provider Business Mailing Address
First Line	:	4917 RICHMOND TAPPAHANNOCK HWY
Second Line	:
City	:	AYLETT
State	:	VA
Zip	:	23009-3416
Country	:	US
Telephone Number	:	804-769-4362
Fax Number	:

Provider Business Practice Location Address
First Line	:	4917 RICHMOND TAPPAHANNOCK HWY
Second Line	:
City	:	AYLETT
State	:	VA
Zip	:	23009-3416
Country	:	US
Telephone Number	:	804-769-4362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	10/30/2014

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