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General NPI Number Information
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NPI Number | 1467454405
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Entity Type | Individual
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Provider Name | CARLA DARAK-BOLINO O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 3921 E MARKET ST BUILDING III SECOND FLOOR
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City | WARREN
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State | OH
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Zip | 44484-4711
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Country | US
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Telephone | 330-856-3300
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Fax | 330-856-4539
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Provider Business Mailing Address
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Address Line | 34 BOARDMAN POLAND RD
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City | BOARDMAN
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State | OH
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Zip | 44512-4601
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Country | US
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Telephone | 330-758-6671
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Fax | 330-758-1451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4982/T1852
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License Number State | OH
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