MEDICARE: DR. ANDREW COUFAL OD

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	3120	OK

General Provider Information

NPI Number	:	1265108815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW COUFAL OD

Provider Business Mailing Address
First Line	:	502 E PROSPECT AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-7404
Country	:	US
Telephone Number	:	580-765-7509
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 E PROSPECT AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-7404
Country	:	US
Telephone Number	:	580-765-7509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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