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General NPI Number Information
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NPI Number | 1386841195
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Entity Type | Organization
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Legal Business Name | DR JEFFREY R COLEMAN OPTOMETRIST PA
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 919 S 16TH ST
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City | WILMINGTON
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State | NC
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Zip | 28401-8015
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Country | US
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Telephone | 910-762-4004
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Fax | 910-762-1605
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Provider Business Mailing Address
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Address Line | 919 S 16TH ST
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City | WILMINGTON
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State | NC
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Zip | 28401-8015
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Country | US
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Telephone | 910-762-4004
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Fax | 910-762-1605
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY COLEMAN
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Credential | OD
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Telephone | 910-762-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | NC1329
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License Number State | NC
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