Provider Demographics
NPI:1376545038
Name:COKER, TROY DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:DALE
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 1:432 WALL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3428
Mailing Address - Country:US
Mailing Address - Phone:812-283-7492
Mailing Address - Fax:812-283-7599
Practice Address - Street 1:432 WALL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3428
Practice Address - Country:US
Practice Address - Phone:812-283-7492
Practice Address - Fax:812-283-7599
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002957B152W00000X
KY1408DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200196340AMedicaid
IN203722741OtherTAX ID
INU70995Medicare UPIN
KY1722301Medicare ID - Type Unspecified
IN196300Medicare ID - Type Unspecified