MEDICARE: DR. JANICE EULA COATES 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	3450 T1613	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23693	OTHER	OH	SPECTERA
2	31238	OTHER	OH	DAVIS VISION
3	360296	OTHER	OH	NATIONAL VISION SERVICE
4	903323	OTHER	OH	BLOCK VISION
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2983	OTHER	OH	VISION OF AMERICA
7	142338	OTHER	OH	EYE MED
8	310981905026	OTHER	OH	CARESOURCE
9	10277	OTHER	OH	COORDINATED VISION CARE
10	142338	OTHER	OH	COLE VISION

General Provider Information

NPI Number	:	1609091982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE EULA COATES O.D.

Provider Business Mailing Address
First Line	:	4387 PARKWAY DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45416-1638
Country	:	US
Telephone Number	:	937-278-7391
Fax Number	:	937-278-9418

Provider Business Practice Location Address
First Line	:	4387 PARKWAY DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45416-1638
Country	:	US
Telephone Number	:	937-278-7391
Fax Number	:	937-278-9418

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/09/2007

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