Provider Demographics
NPI:1235124900
Name:COKER, JAMES M (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:COKER
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 1:1016 S DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-3246
Mailing Address - Country:US
Mailing Address - Phone:843-828-1182
Mailing Address - Fax:843-650-2525
Practice Address - Street 1:1651 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4836
Practice Address - Country:US
Practice Address - Phone:843-650-2400
Practice Address - Fax:843-650-2525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO6866Medicaid
SCT24696Medicare UPIN