Provider Demographics
NPI:1245278068
Name:BOLING, RICHARD CLAYTON II (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLAYTON
Last Name:BOLING
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 OLD US 20 W
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1364
Mailing Address - Country:US
Mailing Address - Phone:574-293-3545
Mailing Address - Fax:574-522-0599
Practice Address - Street 1:2746 OLD US 20 W
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1364
Practice Address - Country:US
Practice Address - Phone:574-293-3545
Practice Address - Fax:574-522-0599
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032196207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100113350AMedicaid
P00442880OtherRAILROAD MEDICARE
P00442880OtherRAILROAD MEDICARE
IN100113350AMedicaid
E61170Medicare UPIN