Provider Demographics
NPI:1003866682
Name:COFFINI, CHRIS J (OD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:J
Last Name:COFFINI
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 1:1192 DOGWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-5454
Mailing Address - Country:US
Mailing Address - Phone:770-860-1919
Mailing Address - Fax:770-860-1607
Practice Address - Street 1:1192 DOGWOOD DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5454
Practice Address - Country:US
Practice Address - Phone:770-860-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2780152W00000X
GAOPT003569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38608100Medicaid
WIU77407Medicare UPIN
WI87839Medicare ID - Type Unspecified