Provider Demographics
NPI:1245323971
Name:COATES OPTICAL LAB INC
Entity type:Organization
Organization Name:COATES OPTICAL LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GAVIN
Authorized Official - Last Name:MCFADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-288-2021
Mailing Address - Street 1:4131 TROY HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116
Mailing Address - Country:US
Mailing Address - Phone:334-288-2021
Mailing Address - Fax:334-288-2012
Practice Address - Street 1:4131 TROY HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116
Practice Address - Country:US
Practice Address - Phone:334-288-2021
Practice Address - Fax:334-288-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS343TA056332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0703300001Medicare NSC
AL000058296Medicare PIN
ALT68589Medicare UPIN