Healthcare Provider Details

I. General information

NPI: 1790678514
Provider Name (Legal Business Name): CARLEY KAY COLEMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 STATE ROUTE 28
MILFORD OH
45150-4940
US

IV. Provider business mailing address

7516 PLAINFIELD RD
DEER PARK OH
45236-3161
US

V. Phone/Fax

Practice location:
  • Phone: 513-831-3166
  • Fax:
Mailing address:
  • Phone: 937-241-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: