Provider Demographics
NPI:1992271480
Name:COLSTON EYE CARE, PLLC
Entity type:Organization
Organization Name:COLSTON EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:COLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-301-5745
Mailing Address - Street 1:5400 PRESTON OAKS RD APT 4014
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8483
Mailing Address - Country:US
Mailing Address - Phone:817-301-5745
Mailing Address - Fax:
Practice Address - Street 1:3150 E BROAD ST
Practice Address - Street 2:STE 120
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-301-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty