Provider Demographics
NPI:1194876680
Name:COFFMAN, STACY A (OD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:14883 HUNTINGTON GATE DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6700
Mailing Address - Country:US
Mailing Address - Phone:858-486-0740
Mailing Address - Fax:858-673-1221
Practice Address - Street 1:12350 CARMEL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4616
Practice Address - Country:US
Practice Address - Phone:858-673-1221
Practice Address - Fax:858-673-1221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10102T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist