Provider Demographics
NPI:1093903619
Name:COERS FAMILY EYECARE PC
Entity Type:Organization
Organization Name:COERS FAMILY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:COERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-418-0080
Mailing Address - Street 1:2525 CALIFORNIA ST STE G
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3678
Mailing Address - Country:US
Mailing Address - Phone:812-418-0080
Mailing Address - Fax:812-418-0090
Practice Address - Street 1:2525 CALIFORNIA ST STE G
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3678
Practice Address - Country:US
Practice Address - Phone:812-418-0080
Practice Address - Fax:812-418-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002988B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200234300BMedicaid
IN220300Medicare PIN
IN5208320001Medicare NSC