Provider Demographics
NPI:1891280020
Name:BOLANO, KRISTO (OD)
Entity Type:Individual
Prefix:
First Name:KRISTO
Middle Name:
Last Name:BOLANO
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 1:1 BOYLSTON ST STE 3E
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1719
Mailing Address - Country:US
Mailing Address - Phone:617-232-3303
Mailing Address - Fax:617-232-3310
Practice Address - Street 1:1 BOYLSTON ST STE 3E
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1719
Practice Address - Country:US
Practice Address - Phone:617-232-3303
Practice Address - Fax:172-323-3106
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist