Provider Demographics
NPI:1992798433
Name:BOLICK, STEPHEN F (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:BOLICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 SIX FORKS RD
Mailing Address - Street 2:#144
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6164
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:7413 SIX FORKS RD
Practice Address - Street 2:#144
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6164
Practice Address - Country:US
Practice Address - Phone:919-847-0187
Practice Address - Fax:919-676-2231
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09111OtherBLUECROSS
NC410048143OtherRAILROAD MEDICARE
NC8909111Medicaid
NC246311CMedicare PIN