MEDICARE: R H BOSTWICK III OD

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	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1821012147	OTHER	MS	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1720265721	OTHER	MS	NPI2

General Provider Information

NPI Number	:	1720265721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R H BOSTWICK III OD

Provider Business Mailing Address
First Line	:	109 STATE HIGHWAY 15 S
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-5206
Country	:	US
Telephone Number	:	662-534-9288
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 STATE HIGHWAY 15 S
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-5206
Country	:	US
Telephone Number	:	662-534-9288
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT H BOSTWICK
Credential	:	OD
Telephone Number	:	662-534-9288

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	05/19/2010

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