Provider Demographics
NPI:1699323162
Name:BOOTS, CRISTELLE ELISE (OD)
Entity type:Individual
Prefix:
First Name:CRISTELLE
Middle Name:ELISE
Last Name:BOOTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CRISTELLE
Other - Middle Name:ELISE
Other - Last Name:BUISSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:STE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3873
Mailing Address - Country:US
Mailing Address - Phone:952-888-5800
Mailing Address - Fax:952-567-6176
Practice Address - Street 1:11091 ULYSSES ST NE STE 300
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4238
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-567-6156
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004193A152W00000X
MN3712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18004193AOtherINDIANA STATE LICENSE