Provider Demographics
NPI:1992856744
Name:COLTOM INC.
Entity Type:Organization
Organization Name:COLTOM INC.
Other - Org Name:CRYSTAL CLEAR OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-686-0553
Mailing Address - Street 1:5443 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4563
Mailing Address - Country:US
Mailing Address - Phone:352-686-0553
Mailing Address - Fax:353-686-0428
Practice Address - Street 1:5443 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4563
Practice Address - Country:US
Practice Address - Phone:352-686-0553
Practice Address - Fax:353-686-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE849332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1318670001Medicare NSC