Provider Demographics
NPI:1518066208
Name:BOLLIN, EMILY 'BAMBI' CHILDRESS (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY 'BAMBI'
Middle Name:CHILDRESS
Last Name:BOLLIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EMILY 'BAMBI'
Other - Middle Name:BARBOUR
Other - Last Name:CHILDRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:23 CYGNET CT
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
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
Practice Address - Country:US
Practice Address - Phone:843-837-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA1910E499OtherMEDICARE
SCP01512740OtherRAILROAD MEDICARE
SCD14624Medicaid
WVV08921Medicare UPIN
WVMC1289190OtherDEA#