Provider Demographics
NPI:1679744437
Name:WILLIAM C COFFEE OD
Entity Type:Organization
Organization Name:WILLIAM C COFFEE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-777-3443
Mailing Address - Street 1:405 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-7104
Mailing Address - Country:US
Mailing Address - Phone:870-777-3443
Mailing Address - Fax:870-777-3266
Practice Address - Street 1:405 W 16TH ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-7104
Practice Address - Country:US
Practice Address - Phone:870-777-3443
Practice Address - Fax:870-777-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0206680001Medicare NSC