Provider Demographics
NPI:1598779019
Name:COOMER, DARCY MINTON (OD)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:MINTON
Last Name:COOMER
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 1:1945 SCOTTSVILLE RD
Mailing Address - Street 2:STE B2 PMB 239
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3376
Mailing Address - Country:US
Mailing Address - Phone:270-796-6021
Mailing Address - Fax:888-834-1659
Practice Address - Street 1:1256 CAMPBELL LN
Practice Address - Street 2:SUITE 106
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1082
Practice Address - Country:US
Practice Address - Phone:270-796-6021
Practice Address - Fax:888-834-1659
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1555DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0067860OtherCIGNA
KY0007243418OtherAETNA
KY000000261068OtherBLUE CROSS BLUE SHIELD
KY77001113Medicaid
KY0067860OtherCIGNA
KY77001113Medicaid