Provider Demographics
NPI:1710047451
Name:COATES, STEPHANIE R (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:R
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 1:1228 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4610
Mailing Address - Country:US
Mailing Address - Phone:727-733-0443
Mailing Address - Fax:727-733-0444
Practice Address - Street 1:1228 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4610
Practice Address - Country:US
Practice Address - Phone:727-733-0443
Practice Address - Fax:727-733-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJQ108OtherMEDICARE
FLJQ106OtherMEDICARE