Provider Demographics
NPI:1083978605
Name:COFFEN, MARGARET (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:COFFEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 N 4TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-2106
Mailing Address - Country:US
Mailing Address - Phone:715-224-2200
Mailing Address - Fax:419-858-9769
Practice Address - Street 1:1334 N 4TH ST SUITE 101
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2137
Practice Address - Country:US
Practice Address - Phone:715-224-2200
Practice Address - Fax:419-858-9769
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1000023903Medicaid