Healthcare Provider Details

I. General information

NPI: 1508673427
Provider Name (Legal Business Name): COLTON MOBILE HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 S COULTER ST
AMARILLO TX
79119-6676
US

IV. Provider business mailing address

601 W FM 544 STE 109M
MURPHY TX
75094-4200
US

V. Phone/Fax

Practice location:
  • Phone: 972-303-2020
  • Fax: 972-476-1195
Mailing address:
  • Phone: 972-303-2020
  • Fax: 972-476-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE ADAM COLTON
Title or Position: OWNER
Credential: OD
Phone: 972-578-2020