Provider Demographics
NPI:1619084910
Name:COOMBS, SHAUN KEITH (OD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:KEITH
Last Name:COOMBS
Suffix:
Gender:M
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:115 NEW VIEW CT NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5250
Practice Address - Country:US
Practice Address - Phone:360-252-1642
Practice Address - Fax:360-252-1646
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI2863152W00000X
AKOPTT200152W00000X
WAOD00003477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410040792OtherRAIL ROAD MEDICARE
WA410040793OtherRAIL ROAD MEDICARE
WA410041455OtherRAIL ROAD MEDICARE
ORR151747OtherMEDICARE OR
ORP00017913OtherRAIL ROAD MEDICARE
AKK162967OtherMEDICARE AK
AKP00012983OtherRAIL ROAD MEDICARE
WAGAB09936Medicare PIN
ORR115950Medicare PIN
WAAB09939Medicare PIN
AKP00012983OtherRAIL ROAD MEDICARE
WA410041455OtherRAIL ROAD MEDICARE
WA410040793OtherRAIL ROAD MEDICARE
ORP00017913OtherRAIL ROAD MEDICARE