Provider Demographics
NPI:1831107515
Name:BOLINGER, MELANIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E SUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2830
Mailing Address - Country:US
Mailing Address - Phone:479-443-4301
Mailing Address - Fax:479-587-5921
Practice Address - Street 1:180 E SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2830
Practice Address - Country:US
Practice Address - Phone:479-443-4301
Practice Address - Fax:479-587-5921
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2480152W00000X
MO2005020645152W00000X
AR2603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist