Dr Jeffrey R Coleman Optometrist PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

NC1329 Issued in NC

Legal business name

DR JEFFREY R COLEMAN OPTOMETRIST PA

Practice address

919 S 16TH St
Wilmington, NC 28401-8015

Phone

(910) 762-4004

Fax

(910) 762-1605

NPI assigned

Jun 27, 2007

Last updated

Mar 4, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Coleman, ODNPI 1326047689

Title

Owner

Phone

(910) 762-4004

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey R Coleman, O.D.

  • Optometrist
  • Wilmington, NC
  • NPI 1326047689
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1386841195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284018015",
            "telephone_number": "910-762-4004",
            "fax_number": "910-762-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284018015",
            "telephone_number": "910-762-4004",
            "fax_number": "910-762-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JEFFREY R COLEMAN OPTOMETRIST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-762-4004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "NC1329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890910G",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "0910G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.