Organization
COFFMAN OPTICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW D FORD LDO (OWNER)
(330) 343-1215
Entity
Organization
Contact information
Practice address
130 S BROADWAY ST, NEW PHILADELPHIA, OH 44663-3829
(330) 343-1215
(330) 343-3673
Mailing address
130 S BROADWAY ST, NEW PHILADELPHIA, OH 44663-3829
(330) 343-1215
(330) 343-3673
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4045S
OH
332H00000X
Eyewear Supplier
4045S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0062829
—
OH
Enumeration date
12/12/2011
Last updated
07/13/2012
Update your record
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