Healthcare Provider Details

I. General information

NPI: 1841468212
Provider Name (Legal Business Name): D. L. BOWLING, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 TAZEWELL ST
PEARISBURG VA
24134-1632
US

IV. Provider business mailing address

PO BOX 638
PEARISBURG VA
24134-0638
US

V. Phone/Fax

Practice location:
  • Phone: 540-921-3921
  • Fax: 540-921-1328
Mailing address:
  • Phone: 540-921-3921
  • Fax: 540-921-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number0618000310
License Number StateVA

VIII. Authorized Official

Name: DR. DANIEL LAYNE BOWLING
Title or Position: PRESIDENT
Credential: O.D.
Phone: 540-921-3921