Provider Demographics
NPI:1356503163
Name:BOLINGER, ALISON R (OD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:R
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SPRINGSIDE DR STE 300C
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4526
Mailing Address - Country:US
Mailing Address - Phone:330-666-0707
Mailing Address - Fax:330-668-4884
Practice Address - Street 1:150 SPRINGSIDE DR STE 300C
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-4526
Practice Address - Country:US
Practice Address - Phone:330-666-0707
Practice Address - Fax:330-668-4884
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5782-T2696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000701024OtherANTHEM
OH3022142Medicaid
OH4240863Medicare PIN
OH3022142Medicaid