Provider Demographics
NPI:1912064262
Name:COLEMAN, JOSHUA (O D)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4210
Mailing Address - Country:US
Mailing Address - Phone:731-644-9180
Mailing Address - Fax:731-642-9180
Practice Address - Street 1:715 MORTON ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4210
Practice Address - Country:US
Practice Address - Phone:731-644-9180
Practice Address - Fax:731-642-9180
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39457641Medicaid
TN6071120001Medicare NSC
TN39457641Medicare PIN
U94979Medicare UPIN