Provider Demographics
NPI:1598836660
Name:BOLLISH, MICHAEL JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BOLLISH
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:6850 N SHILOH RD
Mailing Address - Street 2:SUITE T
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2912
Mailing Address - Country:US
Mailing Address - Phone:972-414-0444
Mailing Address - Fax:972-414-5663
Practice Address - Street 1:6850 N SHILOH RD
Practice Address - Street 2:SUITE T
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2912
Practice Address - Country:US
Practice Address - Phone:972-414-0444
Practice Address - Fax:972-414-5663
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3918T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist