MEDICARE: DR. NEILL JAMES BULAKOWSKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2081	NC

General Provider Information

NPI Number	:	1174709760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEILL JAMES BULAKOWSKI O.D.

Provider Business Mailing Address
First Line	:	6611 BURLINGTON RD
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9748
Country	:	US
Telephone Number	:	336-449-1333
Fax Number	:	336-449-1348

Provider Business Practice Location Address
First Line	:	6611 BURLINGTON RD
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9748
Country	:	US
Telephone Number	:	336-449-1333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/10/2017

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