Provider Demographics
NPI:1174709760
Name:BULAKOWSKI, NEILL JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:NEILL
Middle Name:JAMES
Last Name:BULAKOWSKI
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 1:6611 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9748
Mailing Address - Country:US
Mailing Address - Phone:336-449-1333
Mailing Address - Fax:336-449-1348
Practice Address - Street 1:6611 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9748
Practice Address - Country:US
Practice Address - Phone:336-449-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2081152W00000X
MDTA2068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist