MEDICARE: CRAIG ALAN BOLTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	E3652	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215042775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ALAN BOLTON M.D.

Provider Business Mailing Address
First Line	:	10670 N CENTRAL EXPY
Second Line	:	SUITE 170
City	:	DALLAS
State	:	TX
Zip	:	75231-2111
Country	:	US
Telephone Number	:	214-368-0000
Fax Number	:	214-368-1884

Provider Business Practice Location Address
First Line	:	10670 N CENTRAL EXPY
Second Line	:	SUITE 170
City	:	DALLAS
State	:	TX
Zip	:	75231-2111
Country	:	US
Telephone Number	:	214-368-0000
Fax Number	:	214-368-1884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/29/2008

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