MEDICARE: DR. TIMOTHY S. COUGHLIN 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
1	152W00000X	Optometrist	05837T	CA

General Provider Information

NPI Number	:	1548307168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY S. COUGHLIN O.D.

Provider Business Mailing Address
First Line	:	825 POLLARD RD
Second Line	:	STE 208
City	:	LOS GATOS
State	:	CA
Zip	:	95032-1435
Country	:	US
Telephone Number	:	408-378-1701
Fax Number	:	408-378-2596

Provider Business Practice Location Address
First Line	:	233 N SANTA CRUZ AVE
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95030-7206
Country	:	US
Telephone Number	:	408-354-9310
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	10/03/2016

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