Provider Demographics
NPI:1952021669
Name:COEN, JANSEN JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:JANSEN
Middle Name:JOHN
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 1:3151 S ST APT 252
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7074
Mailing Address - Country:US
Mailing Address - Phone:916-842-7449
Mailing Address - Fax:
Practice Address - Street 1:2831 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4315
Practice Address - Country:US
Practice Address - Phone:916-442-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10674152W00000X
CA35331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist