Provider Demographics
NPI:1922159169
Name:BOLLINGER, CARL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DAVID
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-0127
Mailing Address - Country:US
Mailing Address - Phone:336-766-7373
Mailing Address - Fax:336-766-7382
Practice Address - Street 1:6301 STADIUM DR
Practice Address - Street 2:B
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8766
Practice Address - Country:US
Practice Address - Phone:336-766-7373
Practice Address - Fax:336-766-7382
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561282758OtherAETNA
NC917812OtherEYEMED VISION CARE
NC13283OtherSPECTERA
NC0952390001OtherPALMETTO
NC09114OtherBLUE CROSS BLUE SHIELD
NC561282758OtherAETNA
NC917812OtherEYEMED VISION CARE