MEDICARE: BULAKOWSKI OPTOMETRY PLLC

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	:	1992186555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BULAKOWSKI OPTOMETRY PLLC

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	:	336-449-1348

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. NEILL J BULAKOWSKI
Credential	:	OD
Telephone Number	:	336-449-1333

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	06/09/2015

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