=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205970738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHERINE F COFFEY OD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2007
-----------------------------------------------------
Last Update Date | 12/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 QUARRY ST SUITE 3
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-4174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-481-6650
-----------------------------------------------------
Fax | 617-302-4713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 QUARRY ST SUITE 3
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-4174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-481-6650
-----------------------------------------------------
Fax | 617-302-4713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHERINE F COFFEY
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 617-698-2040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------