Provider Demographics
NPI:1609091982
Name:COATES, JANICE EULA (OD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:EULA
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 1:4387 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1638
Mailing Address - Country:US
Mailing Address - Phone:937-278-7391
Mailing Address - Fax:937-278-9418
Practice Address - Street 1:4387 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1638
Practice Address - Country:US
Practice Address - Phone:937-278-7391
Practice Address - Fax:937-278-9418
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3450 T1613152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH23693OtherSPECTERA
OH31238OtherDAVIS VISION
OH360296OtherNATIONAL VISION SERVICE
OH903323OtherBLOCK VISION
OH0419612Medicaid
OH2983OtherVISION OF AMERICA
OH142338OtherEYE MED
OH310981905026OtherCARESOURCE
OH10277OtherCOORDINATED VISION CARE
OH142338OtherCOLE VISION
OH000000008608Medicare UPIN
OH2983OtherVISION OF AMERICA
OH10277OtherCOORDINATED VISION CARE