MEDICARE: DR. SEAN P COUGHLIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC2778	FL

General Provider Information

NPI Number	:	1154319390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN P COUGHLIN O.D.

Provider Business Mailing Address
First Line	:	13318 BONICA WAY
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-5701
Country	:	US
Telephone Number	:	407-905-6769
Fax Number	:

Provider Business Practice Location Address
First Line	:	7051 DR PHILLIPS BLVD
Second Line	:	SUITE 7
City	:	ORLANDO
State	:	FL
Zip	:	32819-5140
Country	:	US
Telephone Number	:	407-351-3232
Fax Number	:	407-354-3397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/09/2007

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