Provider Demographics
NPI:1841468212
Name:D. L. BOWLING, O.D., P.C.
Entity type:Organization
Organization Name:D. L. BOWLING, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-921-3921
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-0638
Mailing Address - Country:US
Mailing Address - Phone:540-921-3921
Mailing Address - Fax:540-921-1328
Practice Address - Street 1:122 TAZEWELL ST
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1632
Practice Address - Country:US
Practice Address - Phone:540-921-3921
Practice Address - Fax:540-921-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000310332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI009204504Medicaid
VA004178OtherANTHEM BLUE CROSS BLUE SHIELD
45401750OtherAETNA
VA004178OtherANTHEM BLUE CROSS BLUE SHIELD
C10486Medicare PIN