Provider Demographics
NPI:1134255516
Name:BOLARD, JAMES TURNER (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TURNER
Last Name:BOLARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-0718
Mailing Address - Country:US
Mailing Address - Phone:814-734-5193
Mailing Address - Fax:814-734-5193
Practice Address - Street 1:103 ERIE ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412
Practice Address - Country:US
Practice Address - Phone:814-734-5193
Practice Address - Fax:814-734-5193
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0E004354P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT-27092Medicare UPIN