Provider Demographics
NPI:1003831371
Name:BOLLIN, NICHOLAS R (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:R
Last Name:BOLLIN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MALPHRUS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6635
Mailing Address - Country:US
Mailing Address - Phone:843-837-9222
Mailing Address - Fax:843-837-4474
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:29910-6635
Practice Address - Country:US
Practice Address - Phone:843-837-9222
Practice Address - Fax:843-837-4474
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002419152W00000X
SC1463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I410154OtherMEDICARE PTAN
GA511G701032OtherMEDICARE GROUP
SCAA62946830OtherMEDICARE PTAN
SC6830OtherMEDICARE GROUP NUMBER
GA895091476DMedicaid
SCDA9680OtherMEDICAID GROUP NUMBER
SCD14633Medicaid
GAP00684230OtherRAILROAD MEDICARE PTAN
GA895091476FMedicaid
GA895091476FMedicaid
GA895091476DMedicaid
SCAA62946830OtherMEDICARE PTAN