Provider Demographics
NPI:1467454405
Name:DARAK-BOLINO, CARLA (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:DARAK-BOLINO
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 1:34 BOARDMAN POLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4601
Mailing Address - Country:US
Mailing Address - Phone:330-758-6671
Mailing Address - Fax:330-758-1451
Practice Address - Street 1:3921 E MARKET ST
Practice Address - Street 2:BUILDING III SECOND FLOOR
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4711
Practice Address - Country:US
Practice Address - Phone:330-856-3300
Practice Address - Fax:330-856-4539
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4982/T1852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2455927Medicaid
OH2455927Medicaid