Provider Demographics
NPI:1003866682
Name:COFFINI, CHRIS J (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:J
Last Name:COFFINI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-6213
Mailing Address - Country:US
Mailing Address - Phone:920-261-9225
Mailing Address - Fax:920-261-7010
Practice Address - Street 1:701 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-6213
Practice Address - Country:US
Practice Address - Phone:920-261-9225
Practice Address - Fax:920-261-7010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38608100Medicaid
WIU77407Medicare UPIN
WI87839Medicare ID - Type Unspecified