Provider Demographics
NPI:1164620878
Name:BOLTON, CRISSE FOLDS (OD)
Entity type:Individual
Prefix:DR
First Name:CRISSE
Middle Name:FOLDS
Last Name:BOLTON
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-7181
Mailing Address - Country:US
Mailing Address - Phone:706-323-3491
Mailing Address - Fax:205-943-4688
Practice Address - Street 1:6600 WHITTLESEY BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7337
Practice Address - Country:US
Practice Address - Phone:706-323-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSB69TA777152W00000X
GAOPT003532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD299OtherMEDICARE D299
ALH444OtherMEDICARE
ALD299OtherMEDICARE D299