Provider Demographics
NPI:1619936911
Name:JAMES D COFFEY O D P C
Entity Type:Organization
Organization Name:JAMES D COFFEY O D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-323-1515
Mailing Address - Street 1:817 AVANT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3957
Mailing Address - Country:US
Mailing Address - Phone:580-323-1515
Mailing Address - Fax:580-323-2521
Practice Address - Street 1:817 AVANT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3957
Practice Address - Country:US
Practice Address - Phone:580-323-1515
Practice Address - Fax:580-323-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1322540001Medicare NSC