Provider Demographics
NPI:1497797930
Name:AUSTIN WM COLEMAN, DO, PA
Entity Type:Organization
Organization Name:AUSTIN WM COLEMAN, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-597-2792
Mailing Address - Street 1:10661 AIRPORT PULLING RD
Mailing Address - Street 2:#12
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7335
Mailing Address - Country:US
Mailing Address - Phone:239-597-2792
Mailing Address - Fax:239-598-2748
Practice Address - Street 1:10661 AIRPORT PULLING RD
Practice Address - Street 2:#12
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7335
Practice Address - Country:US
Practice Address - Phone:239-597-2792
Practice Address - Fax:239-598-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8806207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9255Medicare PIN