NPIMap

Organization Active NPI

Coffman Vision Clinic Inc

  • Optometrist
  • Bend, OR
National Provider Identifier
1811064967
Registry record updated Apr 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2508T Issued in OR
Legal business name
COFFMAN VISION CLINIC INC
Practice address
61535 S Highway 97
Ste. 16
Bend, OR 97702-2154
Phone
(541) 389-4774
Fax
(541) 389-3971
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2015

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

Authorized official

Name
Dr. Michael A Coffman, O.D.NPI 1982799789
Title
President
Phone
(541) 389-4774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2508T OR Primary

Addresses

Primary practice location

61535 S Highway 97
Ste. 16
Bend, OR 97702-2154

Mailing address

61535 S Highway 97
Ste. 16
Bend, OR 97702-2154
Phone (541) 389-4774

Other identifiers 2

IdentifierTypeStateIssuer
1982799789OtherORINDIVIDUAL NPI
R116227OtherORMEDICARE GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040413001839 OR Part B Supplier - Clinic/Group Practice 8123012903 Receives reassigned benefits from 7 practitioners
Practice locations: Bend, OR

National Provider Directory

National Provider Directory

Locations

61535 S Highway 97
Ste 16
Bend, OR 97702
Phone (541) 389-4774

61535 S Highway 97
Ste 13
Bend, OR 97702
Phone (541) 389-4774

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1811064967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61535 S HIGHWAY 97",
            "address_2": "STE. 16",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022154",
            "telephone_number": "541-389-4774",
            "fax_number": "541-389-3971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61535 S HIGHWAY 97",
            "address_2": "STE. 16",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022154",
            "telephone_number": "541-389-4774",
            "fax_number": "541-389-3971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFMAN VISION CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "COFFMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-389-4774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2508T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1982799789",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "R116227",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; 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.