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NPI Code Detail

MEDICARE: DR. STACY A COFFMAN O.D.

MEDICARE: DR. STACY A COFFMAN O.D.
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
1152W00000XOptometrist10102TCA

General Provider Information

NPI Number : 1194876680
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY A COFFMAN O.D.
Provider Business Mailing Address
First Line : 14883 HUNTINGTON GATE DR
Second Line :
City : POWAY
State : CA
Zip : 92064-6700
Country : US
Telephone Number : 858-486-0740
Fax Number : 858-673-1221
Provider Business Practice Location Address
First Line : 12350 CARMEL MOUNTAIN RD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-4616
Country : US
Telephone Number : 858-673-1221
Fax Number : 858-673-1221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2007
Last Update Date : 07/08/2007

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