Provider Demographics
NPI:1235630419
Name:COATS, JOHNNY (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:COATS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREENLAWN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2926
Mailing Address - Country:US
Mailing Address - Phone:631-423-3323
Mailing Address - Fax:
Practice Address - Street 1:8 GREENLAWN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2926
Practice Address - Country:US
Practice Address - Phone:631-423-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009230-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician