Provider Demographics
NPI:1093799850
Name:COFFMAN, MICHELE ALEXIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ALEXIS
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32351 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1513
Mailing Address - Country:US
Mailing Address - Phone:480-575-7518
Mailing Address - Fax:480-575-7542
Practice Address - Street 1:32351 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1513
Practice Address - Country:US
Practice Address - Phone:480-575-7518
Practice Address - Fax:480-575-7542
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ591553Medicaid
AZZ143834Medicare UPIN