Provider Demographics
NPI:1679617104
Name:COFFEY, KATHERINE F (OD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:F
Last Name:COFFEY
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 1:104 QUARRY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4175
Mailing Address - Country:US
Mailing Address - Phone:617-481-6650
Mailing Address - Fax:617-302-4713
Practice Address - Street 1:104 QUARRY ST STE 3
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-481-6650
Practice Address - Fax:617-302-4713
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005432OtherNHP
725467OtherTUFTS
W15874OtherBCBS
152010OtherHPHC
725467OtherTUFTS
0005432OtherNHP
MA0356689Medicaid
U32158Medicare UPIN
MA457158Medicare PIN