Healthcare Provider Details

I. General information

NPI: 1538448337
Provider Name (Legal Business Name): HEATH ALLEN COLEMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 UNICORN LAKE BLVD STE. 100
DENTON TX
76210
US

IV. Provider business mailing address

3111 UNICORN LAKE BLVD STE. 100
DENTON TX
76210
US

V. Phone/Fax

Practice location:
  • Phone: 940-891-3937
  • Fax: 940-591-8368
Mailing address:
  • Phone: 940-891-3937
  • Fax: 940-591-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2689
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7840TG
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number784OT
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: