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General NPI Number Information
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NPI Number | 1851656847
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Entity Type | Individual
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Provider Name | ERIC D COY O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 7200 HARRISON AVE
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City | ROCKFORD
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State | IL
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Zip | 61112-1033
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Country | US
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Telephone | 815-332-5733
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Fax | 815-332-4196
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Provider Business Mailing Address
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Address Line | 22519 S COUNTRY LANE
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City | NEW LENOX
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State | IL
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Zip | 60451-3697
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Country | US
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Telephone | 815-546-0107
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Fax |
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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 | 046010571
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License Number State | IL
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