Provider Demographics
NPI:1851656847
Name:COY, ERIC D (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:COY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22519 S COUNTRY LANE
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3697
Mailing Address - Country:US
Mailing Address - Phone:815-546-0107
Mailing Address - Fax:
Practice Address - Street 1:7200 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1033
Practice Address - Country:US
Practice Address - Phone:815-332-5733
Practice Address - Fax:815-332-4196
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist