Individual
RICHARD CLAYTON BOLING II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2746 OLD US 20 W, ELKHART, IN 46514-1364
(574) 293-3545
(574) 522-0599
Mailing address
2746 OLD US 20 W, ELKHART, IN 46514-1364
(574) 293-3545
(574) 522-0599
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01032196
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100113350A
—
IN
01
—
P00442880
RAILROAD MEDICARE
—
Enumeration date
06/03/2006
Last updated
11/08/2012
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