Provider Demographics
NPI:1083742670
Name:CRAIG A BOLTON MD PA
Entity Type:Organization
Organization Name:CRAIG A BOLTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-368-0000
Mailing Address - Street 1:10670 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2111
Mailing Address - Country:US
Mailing Address - Phone:214-368-0000
Mailing Address - Fax:214-368-1884
Practice Address - Street 1:10670 N CENTRAL EXPY
Practice Address - Street 2:SUITE 170
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2111
Practice Address - Country:US
Practice Address - Phone:214-368-0000
Practice Address - Fax:214-368-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00064RMedicare ID - Type Unspecified