Provider Demographics
NPI:1497805154
Name:SPECTCLES INCDBA COFFMAN OPTICAL
Entity Type:Organization
Organization Name:SPECTCLES INCDBA COFFMAN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:419-626-6530
Mailing Address - Street 1:130 W PERKINS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4801
Mailing Address - Country:US
Mailing Address - Phone:419-626-6530
Mailing Address - Fax:419-626-6534
Practice Address - Street 1:130 W PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4801
Practice Address - Country:US
Practice Address - Phone:419-626-6530
Practice Address - Fax:419-626-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2275103Medicaid