Provider Demographics
NPI:1942038609
Name:COLBERT, TONY DUVALL (COA)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:DUVALL
Last Name:COLBERT
Suffix:
Gender:M
Credentials:COA
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 SOUTH LANCASTER ROAD
Mailing Address - Street 2:EYE CLINIC (CLINIC 1)
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216
Mailing Address - Country:US
Mailing Address - Phone:214-857-4688
Mailing Address - Fax:
Practice Address - Street 1:4500 SOUTH LANCASTER ROAD
Practice Address - Street 2:EYE CLINIC (CLINIC 1)
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-857-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-08-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant