Coos Eye Centers, Inc.
Organization Active NPI Optometrist · Coquille, OR
NPI 1508069428 · NPPES record last updated Sep 29, 2009
Key facts
- NPI
- 1508069428
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2856ATI (OR)
- Legal business name
- COOS EYE CENTERS, INC.
- Practice address
- 855 W Central St
Coquille, OR 97423-1290 - Phone
- (541) 396-4042
- NPI assigned
- Jun 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Nicole Rush Erenfeld, O.D.
- Title
- Owner
- Phone
- (541) 396-4042
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 5
-
Morgan Grove, OD
-
Nicole A Rush, OD
-
John B. Rush, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Coquille Vision Center |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040412000538 | OR | Part B Supplier - Clinic/Group Practice | 0547254724 |
Receives reassigned benefits from 5 practitioners 2 other NPIs on this enrollment Practice locations: Bandon, OR; Coquille, OR; Gold Beach, OR |
| O20100930039963 | OR | DME Supplier - Physician - Optometrist | 0547254724 | Practice locations: Coquille, OR |
National Provider Directory
- Tax ID family
- Coos Eye Center Inc
Locations
855 W Central Blvd
Ste A
Coquille, OR 97423
Phone (541) 396-4042
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2856ATI | OR | Yes |
Addresses
Primary practice location
855 W Central St
Coquille, OR 97423-1290
Mailing address
PO Box 489
Coquille, OR 97423-0489
Phone (541) 396-4042
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 287017 | Medicaid | OR |
Other names
- Coquille Vision Center
Other providers in Coquille, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.