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NPI Code Detail

MEDICARE: ANDREW MICHAEL BOLLES O.D.

MEDICARE: ANDREW MICHAEL BOLLES 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
1152W00000XOptometristOPC4651FL
2152W00000XOptometrist4901004775MI

General Provider Information

NPI Number : 1720362585
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW MICHAEL BOLLES O.D.
Provider Business Mailing Address
First Line : 1950 OLD GALLOWS RD STE 520
Second Line :
City : VIENNA
State : VA
Zip : 22182-3970
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 100 NORTH AVE
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49017-3417
Country : US
Telephone Number : 269-962-7595
Fax Number : 269-963-9202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2011
Last Update Date : 10/01/2021

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