Provider Demographics
NPI:1306004171
Name:DR F DONALD COLLEY OPTOMETRIST P A
Entity Type:Organization
Organization Name:DR F DONALD COLLEY OPTOMETRIST P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:COLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-433-0327
Mailing Address - Street 1:2105 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-5117
Mailing Address - Country:US
Mailing Address - Phone:850-433-0327
Mailing Address - Fax:850-432-2159
Practice Address - Street 1:2105 TOWN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-5117
Practice Address - Country:US
Practice Address - Phone:850-433-0327
Practice Address - Fax:850-432-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC811332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084263000Medicaid
FLT93733Medicare UPIN
FL0511660001Medicare NSC