Provider Demographics
NPI:1982896957
Name:DR COKER FAMILY EYE CARE CENTER INC
Entity Type:Organization
Organization Name:DR COKER FAMILY EYE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-283-7492
Mailing Address - Street 1:432 WALL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3428
Mailing Address - Country:US
Mailing Address - Phone:122-837-4928
Mailing Address - Fax:812-283-7599
Practice Address - Street 1:432 WALL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3428
Practice Address - Country:US
Practice Address - Phone:122-837-4928
Practice Address - Fax:812-283-7599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR COKER FAMILY EYE CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-14
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1408DT152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2715Medicaid
KY1722301Medicare PIN