Provider Demographics
NPI:1649239112
Name:BOWLING, DANIEL LAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LAYNE
Last Name:BOWLING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:D
Other - Middle Name:L
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, PC
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:122 TAZEWELL STREET
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-0638
Mailing Address - Country:US
Mailing Address - Phone:540-921-3921
Mailing Address - Fax:540-921-1328
Practice Address - Street 1:122 TAZEWELL ST
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1632
Practice Address - Country:US
Practice Address - Phone:540-921-3921
Practice Address - Fax:540-921-1328
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000310152W00000X
WV710D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4540178OtherAETNA
VA009204504Medicaid
VA004178OtherANTHEM HEALTHKEEPERS
1461175OtherUNITED MINEWORKERS OF AME
004178OtherBLUE CROSS BLUE SHIELD
004178OtherBLUE CROSS BLUE SHIELD
VA009204504Medicaid
VA410049356Medicare PIN
1461175OtherUNITED MINEWORKERS OF AME
00X706D86Medicare PIN