Provider Demographics
NPI:1932168093
Name:COEN, HARRY CRAIG (OD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:CRAIG
Last Name:COEN
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 1:303 N 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577
Mailing Address - Country:US
Mailing Address - Phone:641-673-4366
Mailing Address - Fax:641-673-4825
Practice Address - Street 1:303 N 1ST STREET
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577
Practice Address - Country:US
Practice Address - Phone:641-673-4366
Practice Address - Fax:641-673-4825
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0142174Medicaid
22480OtherWELLMARK
241685OtherMIDLANDS CHOICE
22480Medicare ID - Type Unspecified
IA0142174Medicaid
241685OtherMIDLANDS CHOICE