Provider Demographics
NPI:1437639507
Name:PVBOLLIN, LLC
Entity Type:Organization
Organization Name:PVBOLLIN, LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY 'BAMBI'
Authorized Official - Middle Name:CHILDRESS
Authorized Official - Last Name:BOLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-546-3296
Mailing Address - Street 1:23 CYGNET CT
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1973
Mailing Address - Country:US
Mailing Address - Phone:304-546-3296
Mailing Address - Fax:
Practice Address - Street 1:3 MALPHRUS RD STE 101
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6635
Practice Address - Country:US
Practice Address - Phone:843-837-9222
Practice Address - Fax:843-837-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty