Healthcare Provider Details

I. General information

NPI: 1992186555
Provider Name (Legal Business Name): BULAKOWSKI OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 BURLINGTON RD
WHITSETT NC
27377-9748
US

IV. Provider business mailing address

6611 BURLINGTON RD
WHITSETT NC
27377-9748
US

V. Phone/Fax

Practice location:
  • Phone: 336-449-1333
  • Fax: 336-449-1348
Mailing address:
  • Phone: 336-449-1333
  • Fax: 336-449-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2081
License Number StateNC

VIII. Authorized Official

Name: DR. NEILL J BULAKOWSKI
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 336-449-1333