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General NPI Number Information
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NPI Number | 1073737060
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Entity Type | Organization
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Legal Business Name | VISUAL HEALTH AT JUPITER EYE CENTER LLC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 102 COASTAL WAY
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City | JUPITER
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State | FL
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Zip | 33477-5004
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Country | US
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Telephone | 561-747-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 2889 10TH AVE N STE 305
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City | LAKE WORTH
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State | FL
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Zip | 33461-3045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOM COFFMAN
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Credential | MD
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Telephone | 561-747-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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