Healthcare Provider Details

I. General information

NPI: 1609091982
Provider Name (Legal Business Name): JANICE EULA COATES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4387 PARKWAY DR
DAYTON OH
45416-1638
US

IV. Provider business mailing address

4387 PARKWAY DR
DAYTON OH
45416-1638
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-7391
  • Fax: 937-278-9418
Mailing address:
  • Phone: 937-278-7391
  • Fax: 937-278-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3450 T1613
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: