Individual
DR. KEVIN THOMAS COOLBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1960 ELECTRIC RD, ROANOKE, VA 24018-1621
(540) 772-7171
(540) 774-8299
Mailing address
1960 ELECTRIC RD, ROANOKE, VA 24018-1621
(540) 772-7171
(540) 774-8299
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0601002107
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9232800
—
VA
Enumeration date
06/22/2005
Last updated
02/02/2010
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