Provider Demographics
NPI:1558417840
Name:COATES, KAREN ANN (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:COATES
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 1:4314 MILAN RD
Mailing Address - Street 2:UNIT 200
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5897
Mailing Address - Country:US
Mailing Address - Phone:419-625-7904
Mailing Address - Fax:419-625-7833
Practice Address - Street 1:4314 MILAN RD
Practice Address - Street 2:UNIT 200
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5897
Practice Address - Country:US
Practice Address - Phone:419-625-7904
Practice Address - Fax:419-625-7833
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKASP01301Medicare ID - Type Unspecified
OHCO0653353Medicare ID - Type UnspecifiedINDIVIDUAL
OHUO3009Medicare UPIN