Individual
DR. KIERSTEN COON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
144 MONROE CENTER ST NW, GRAND RAPIDS, MI 49503-2802
(616) 459-0641
(616) 459-0621
Mailing address
144 MONROE CENTER ST NW, GRAND RAPIDS, MI 49503-2802
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
4901004219
MI
152WP0200X
Pediatric Optometrist
Primary
4901004219
MI
152WV0400X
Vision Therapy Optometrist
4901004219
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4599036
—
MI
01
—
5474550001
ADMINASTAR SUPPLY #
MI
01
—
900D114840
BCBS PIN NUMBER
MI
Enumeration date
06/07/2006
Last updated
06/25/2013
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