Healthcare Provider Details

I. General information

NPI: 1235069287
Provider Name (Legal Business Name): COOS BAY VISION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 CENTRAL AVE
COOS BAY OR
97420-1736
US

IV. Provider business mailing address

986 CENTRAL AVE
COOS BAY OR
97420-1736
US

V. Phone/Fax

Practice location:
  • Phone: 541-267-4224
  • Fax: 541-269-7357
Mailing address:
  • Phone: 541-267-4224
  • Fax: 541-269-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE A RUSH
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 541-247-7212