Provider Demographics
NPI:1114080942
Name:COLMAN, ERIC STEVEN (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STEVEN
Last Name:COLMAN
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 1:332 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4058
Mailing Address - Country:US
Mailing Address - Phone:718-965-2545
Mailing Address - Fax:718-965-2545
Practice Address - Street 1:332 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4058
Practice Address - Country:US
Practice Address - Phone:718-965-2545
Practice Address - Fax:718-965-2545
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003856-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00965408Medicaid
NY00965408Medicaid