Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2780 | WI |
NPI | 1003866682 |
---|---|
Provider Name | Dr. Chris J Coffini |
First Address | Watertown, WI 53094-6213 |
Second Address | Watertown, WI 53094-6213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38608100 | (05) | WI |
U77407 | (02) | WI |