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General NPI Number Information
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NPI Number | 1437639507
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Entity Type | Organization
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Legal Business Name | PVBOLLIN, LLC
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Dates
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Enumeration Date | 08/18/2018
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Last Update Date | 08/18/2018
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Provider Practice Location Address
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Address Line | 3 MALPHRUS RD STE 101
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City | BLUFFTON
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State | SC
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Zip | 29910-6635
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Country | US
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Telephone | 843-837-9222
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Fax | 843-837-9343
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Provider Business Mailing Address
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Address Line | 23 CYGNET CT
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City | HILTON HEAD
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State | SC
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Zip | 29926-1973
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Country | US
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Telephone | 304-546-3296
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Fax |
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Authorized Official
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Title or Position | OD/ OWNER
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Name | EMILY 'BAMBI' CHILDRESS BOLLIN
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Credential | OD
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Telephone | 304-546-3296
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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 |
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License Number State | SC
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