Provider Demographics
NPI:1922077734
Name:COOGAN, MARGARET ANN (OD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:COOGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2194 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4242
Mailing Address - Country:US
Mailing Address - Phone:937-438-1717
Mailing Address - Fax:937-438-3469
Practice Address - Street 1:2194 HEWITT AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-4242
Practice Address - Country:US
Practice Address - Phone:937-438-1717
Practice Address - Fax:937-438-3469
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3944 T783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0672151Medicaid
OH0672151Medicaid
OHT48668Medicare UPIN