Provider Demographics
NPI:1306277587
Name:COADY, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:5204 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1913
Practice Address - Country:US
Practice Address - Phone:517-886-2888
Practice Address - Fax:517-866-6099
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004822152W00000X
PAOEG004228152W00000X
IN18003827A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306277587Medicaid
INMI1772Medicare PIN
MI0C97655Medicare PIN
MI1306277587Medicaid