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General NPI Number Information
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NPI Number | 1619084910
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Entity Type | Individual
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Provider Name | SHAUN KEITH COOMBS OD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 115 NEW VIEW CT NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5250
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Country | US
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Telephone | 360-252-1642
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Fax | 360-252-1646
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Provider Business Mailing Address
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Address Line | PO BOX 1506
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City | CHEHALIS
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State | WA
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Zip | 98532-0409
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Country | US
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Telephone | 360-242-3008
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Fax | 360-807-7687
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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 | ATI2863
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License Number State | OR
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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 | OPTT200
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003477
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License Number State | WA
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