MEDICARE: DR. CARRIE JEAN BOLEN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9188T	TX

General Provider Information

NPI Number	:	1598295255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE JEAN BOLEN OD

Provider Business Mailing Address
First Line	:	2071 CYPRESS CREEK RD
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-3622
Country	:	US
Telephone Number	:	512-250-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2071 CYPRESS CREEK RD
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-3622
Country	:	US
Telephone Number	:	512-250-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/21/2022

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