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General NPI Number Information
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NPI Number | 1649239112
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Entity Type | Individual
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Provider Name | DANIEL LAYNE BOWLING OD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 122 TAZEWELL ST
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City | PEARISBURG
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State | VA
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Zip | 24134-1632
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Country | US
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Telephone | 540-921-3921
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Fax | 540-921-1328
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Provider Business Mailing Address
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Address Line | PO BOX 638 122 TAZEWELL STREET
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City | PEARISBURG
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State | VA
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Zip | 24134-0638
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Country | US
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Telephone | 540-921-3921
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Fax | 540-921-1328
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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 | 0618000310
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 710D
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License Number State | WV
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