Provider Demographics
NPI:1770622615
Name:COLEMAN, DAVID BRYAN (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRYAN
Last Name:COLEMAN
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 1:523 LEIGHWAY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2311
Mailing Address - Country:US
Mailing Address - Phone:859-623-6812
Mailing Address - Fax:859-623-6115
Practice Address - Street 1:523 LEIGHWAY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2311
Practice Address - Country:US
Practice Address - Phone:859-623-6812
Practice Address - Fax:859-623-6115
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY891DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008910Medicaid
KY62266OtherBCBS
KY62266OtherBCBS
KY77008910Medicaid