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General NPI Number Information
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NPI Number | 1518066208
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Entity Type | Individual
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Provider Name | EMILY 'BAMBI' CHILDRESS BOLLIN O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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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
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Country | US
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Telephone | 843-837-9222
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Fax |
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Provider Business Mailing Address
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Address Line | 23 CYGNET CT
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City | HILTON HEAD ISLAND
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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 |
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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 | 1462
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License Number State | SC
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