MEDICARE: MICHAEL BOLLISH, O.D. P.C.

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	3918	TX

General Provider Information

NPI Number	:	1396924494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL BOLLISH, O.D. P.C.

Provider Business Mailing Address
First Line	:	6850 N SHILOH ROAD SUITE T
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-2918
Country	:	US
Telephone Number	:	972-414-0444
Fax Number	:	972-414-5663

Provider Business Practice Location Address
First Line	:	6850 NORTH SHILOH ROAD STE T
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-2918
Country	:	US
Telephone Number	:	972-414-0444
Fax Number	:	972-414-5663

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL JAMES BOLLISH
Credential	:	O.D.
Telephone Number	:	972-414-0444

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	04/15/2008

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