Provider Demographics
NPI:1407874993
Name:COY, DEBBIE S (OD)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:S
Last Name:COY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100679010BMedicaid
OK$$$$$$$$$001OtherBCBS
U81734Medicare UPIN
OK410047663Medicare PIN
OK3991960001Medicare NSC
OKOKA101063Medicare PIN