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General NPI Number Information
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NPI Number | 1003296120
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Entity Type | Individual
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Provider Name | STEPHEN D. BOLLINGER O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 2946 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-7861
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Country | US
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Telephone | 636-240-1516
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Fax |
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Provider Business Mailing Address
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Address Line | 514 WARREN COUNTY CTR
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City | WARRENTON
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State | MO
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Zip | 63383-3023
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Country | US
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Telephone | 636-377-2054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2015015577
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License Number State | MO
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