Provider Demographics
NPI:1902020050
Name:COFFEY, JAMES DOYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOYLE
Last Name:COFFEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:817 AVANT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3957
Mailing Address - Country:US
Mailing Address - Phone:580-323-1515
Mailing Address - Fax:580-323-2521
Practice Address - Street 1:817 AVANT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3957
Practice Address - Country:US
Practice Address - Phone:580-323-1515
Practice Address - Fax:580-323-2521
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU35319Medicare UPIN