Organization
PVBLUFFTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS BOLLIN (OWNER)
(304) 382-2542
Entity
Organization
Contact information
Practice address
3 MALPHRUS RD STE 101, BLUFFTON, SC 29910-6635
(843) 837-9222
Mailing address
3 MALPHRUS RD STE 101, BLUFFTON, SC 29910-6635
(843) 837-9222
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
15029
SC
Other
Enumeration date
04/04/2014
Last updated
04/04/2014
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