NPIMap

Organization Active NPI

Colston Eye Care, PLLC

  • Optometrist
  • Mansfield, TX
National Provider Identifier
1992271480
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
COLSTON EYE CARE, PLLC
Practice address
3150 E Broad St
Ste 120
Mansfield, TX 76063
Phone
(817) 301-5745
NPI assigned
Oct 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Benjamin Dean Colston, ODNPI 1083135404
Title
Optometrist/Owner
Phone
(817) 301-5745

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

3150 E Broad St
Ste 120
Mansfield, TX 76063

Mailing address

5400 Preston Oaks Rd Apt 4014
Dallas, TX 75254-8483
Phone (817) 301-5745

Other names 1

  • Eyes on Broad Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190124003320 TX Part B Supplier - Clinic/Group Practice 6800133141 Receives reassigned benefits from 4 practitioners
Practice locations: Mansfield, TX

National Provider Directory

National Provider Directory

Locations

3150 E Broad St
Ste 120
Mansfield, TX 76063
Phone (817) 301-5745

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1992271480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 PRESTON OAKS RD APT 4014",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752548483",
            "telephone_number": "817-301-5745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 E BROAD ST",
            "address_2": "STE 120",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "76063",
            "telephone_number": "817-301-5745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLSTON EYE CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "COLSTON",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "817-301-5745",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyes on Broad",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.