Provider Demographics
NPI:1770508889
Name:COLEMAN, DAVID R (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1030 SE MURPHY BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5043
Mailing Address - Country:US
Mailing Address - Phone:417-782-3488
Mailing Address - Fax:417-782-8150
Practice Address - Street 1:1030 SE MURPHY BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5043
Practice Address - Country:US
Practice Address - Phone:417-782-3488
Practice Address - Fax:417-782-8150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02322152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO311427801Medicaid
KS100090450BMedicaid
KS100090450BMedicaid