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General NPI Number Information
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NPI Number | 1497222772
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Entity Type | Individual
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Provider Name | MADELINE COUGHLIN OD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2015 N MAIN ST
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City | WHEATON
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State | IL
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Zip | 60187-3152
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Country | US
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Telephone | 630-668-8250
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Fax | 630-221-0019
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Provider Business Mailing Address
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Address Line | 2015 N MAIN ST
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City | WHEATON
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State | IL
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Zip | 60187-3190
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Country | US
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Telephone | 630-668-8250
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Fax | 630-221-0019
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0618002693
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046011230
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License Number State | IL
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