Healthcare Provider Details

I. General information

NPI: 1164845418
Provider Name (Legal Business Name): COLEMAN OPTOMETRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SE MURPHY BLVD
JOPLIN MO
64801-5043
US

IV. Provider business mailing address

1030 SE MURPHY BLVD
JOPLIN MO
64801-5043
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-3488
  • Fax: 417-782-8150
Mailing address:
  • Phone: 417-782-3488
  • Fax: 417-782-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTO2322
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTO2322
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTO2322
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTO2322
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberTO2322
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTO2322
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberTO2322
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID R COLEMAN
Title or Position: PRESIDENT/TREASURER
Credential: OD
Phone: 417-782-3488