Healthcare Provider Details

I. General information

NPI: 1346363413
Provider Name (Legal Business Name): DAVID WILLIAM COFFMAN ABOC LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 CLEVELAND ST
ELYRIA OH
44035-4106
US

IV. Provider business mailing address

720 CLEVELAND ST
ELYRIA OH
44035-4106
US

V. Phone/Fax

Practice location:
  • Phone: 440-365-3363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number64S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: