Provider Demographics
NPI:1780736876
Name:COBURN, STEVEN W (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:COBURN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3327 COLORADO BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6865
Mailing Address - Country:US
Mailing Address - Phone:940-566-3413
Mailing Address - Fax:940-381-1828
Practice Address - Street 1:3327 COLORADO BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6865
Practice Address - Country:US
Practice Address - Phone:940-566-3413
Practice Address - Fax:940-381-1828
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2596TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81140QOtherBLUECROSSBLUESHIELD
TX8F0688Medicare PIN
TX81140QOtherBLUECROSSBLUESHIELD
TX5376670001Medicare NSC