MEDICARE: ANGELA DEE COATES OPTOMETRIST

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	2342 FL OPC	FL

General Provider Information

NPI Number	:	1821200973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DEE COATES OPTOMETRIST

Provider Business Mailing Address
First Line	:	PO BOX 770965
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33077-0965
Country	:	US
Telephone Number	:	954-345-7812
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 NW 89TH DR
Second Line	:	#2520
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065
Country	:	US
Telephone Number	:	954-345-7812
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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