Provider Demographics
NPI:1215042775
Name:BOLTON, CRAIG ALAN (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:BOLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3652207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114331504Medicaid
TX114331504Medicaid
B21368Medicare UPIN