MEDICARE: DR MICHELE A COFFMAN PC

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	1785	AZ

General Provider Information

NPI Number	:	1770889800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MICHELE A COFFMAN PC

Provider Business Mailing Address
First Line	:	32351 N SCOTTSDALE RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85266-1513
Country	:	US
Telephone Number	:	480-575-7518
Fax Number	:	480-575-7542

Provider Business Practice Location Address
First Line	:	32351 N SCOTTSDALE RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85266-1513
Country	:	US
Telephone Number	:	480-575-7518
Fax Number	:	480-575-7542

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHELE ALEXIS COFFMAN
Credential	:	O.D.
Telephone Number	:	480-575-7518

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	09/23/2021

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