MEDICARE: DEBBIE S. COY, O.D. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2297	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	444749078001	OTHER	OK	BCBS

General Provider Information

NPI Number	:	1164737151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBBIE S. COY, O.D. P.C.

Provider Business Mailing Address
First Line	:	330 E HIGHWAY 62
Second Line	:
City	:	FORT GIBSON
State	:	OK
Zip	:	74434-8446
Country	:	US
Telephone Number	:	918-478-8888
Fax Number	:	918-478-3465

Provider Business Practice Location Address
First Line	:	330 E HIGHWAY 62
Second Line	:
City	:	FORT GIBSON
State	:	OK
Zip	:	74434-8446
Country	:	US
Telephone Number	:	918-478-8888
Fax Number	:	918-478-3465

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. DEBBIE S. COY
Credential	:	O.D.
Telephone Number	:	918-478-8888

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	07/12/2011

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