Individual
SHAUN KEITH COOMBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
115 NEW VIEW CT NE, OLYMPIA, WA 98506-5250
(360) 252-1642
(360) 252-1646
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ATI2863
OR
152W00000X
Optometrist
Primary
OD00003477
WA
152W00000X
Optometrist
OPTT200
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410040792
RAIL ROAD MEDICARE
WA
01
—
410040793
RAIL ROAD MEDICARE
WA
01
—
410041455
RAIL ROAD MEDICARE
WA
01
—
K162967
MEDICARE AK
AK
01
—
P00012983
RAIL ROAD MEDICARE
AK
01
—
P00017913
RAIL ROAD MEDICARE
OR
01
—
R151747
MEDICARE OR
OR
Enumeration date
08/23/2006
Last updated
11/19/2020
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