Provider Demographics
NPI:1598295255
Name:BOLEN, CARRIE JEAN (OD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:JEAN
Last Name:BOLEN
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 1:2071 CYPRESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3622
Mailing Address - Country:US
Mailing Address - Phone:512-250-1700
Mailing Address - Fax:
Practice Address - Street 1:2071 CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3622
Practice Address - Country:US
Practice Address - Phone:512-250-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9188T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist