Provider Demographics
NPI:1316615743
Name:COLEMAN, CASSIDY (OD)
Entity type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 DRIP DR
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-2009
Mailing Address - Country:US
Mailing Address - Phone:828-371-8770
Mailing Address - Fax:
Practice Address - Street 1:1091 HWY 64 W
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-9657
Practice Address - Country:US
Practice Address - Phone:828-389-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist