Provider Demographics
NPI:1164737151
Name:DEBBIE S. COY, O.D. P.C.
Entity Type:Organization
Organization Name:DEBBIE S. COY, O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-478-8888
Mailing Address - Street 1:330 E HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-8446
Mailing Address - Country:US
Mailing Address - Phone:918-478-8888
Mailing Address - Fax:918-478-3465
Practice Address - Street 1:330 E HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-8446
Practice Address - Country:US
Practice Address - Phone:918-478-8888
Practice Address - Fax:918-478-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200313220AMedicaid
OK444749078001OtherBCBS
OKOKA101062Medicare PIN
OKDR4157Medicare PIN
OK3991960001Medicare NSC