Provider Demographics
NPI:1154319390
Name:COUGHLIN, SEAN P (OD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:P
Last Name:COUGHLIN
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 1:13318 BONICA WAY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5701
Mailing Address - Country:US
Mailing Address - Phone:407-905-6769
Mailing Address - Fax:
Practice Address - Street 1:7051 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5140
Practice Address - Country:US
Practice Address - Phone:407-351-3232
Practice Address - Fax:407-354-3397
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7066Medicare ID - Type UnspecifiedM-CARE #
FLU4134ZMedicare UPIN