Provider Demographics
NPI:1487628988
Name:BOLTON, CHRISTINE D (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:D
Last Name:BOLTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 TEAL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2463
Mailing Address - Country:US
Mailing Address - Phone:765-477-2020
Mailing Address - Fax:765-477-8200
Practice Address - Street 1:1400 TEAL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2463
Practice Address - Country:US
Practice Address - Phone:765-477-2020
Practice Address - Fax:765-477-8200
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU77089Medicare UPIN
IN144440Medicare PIN