Healthcare Provider Details

I. General information

NPI: 1235120106
Provider Name (Legal Business Name): WILLIAM C COFFEE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 16TH ST
HOPE AR
71801-7104
US

IV. Provider business mailing address

PO BOX 597
HOPE AR
71802-0597
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-3443
  • Fax: 870-777-3266
Mailing address:
  • Phone: 870-777-3443
  • Fax: 870-777-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2043
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: