Provider Demographics
NPI:1568157576
Name:COONS, TAYLOR LYNN (OD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LYNN
Last Name:COONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:1170 N ESTRELLA PKWY STE A105
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9276
Practice Address - Country:US
Practice Address - Phone:623-932-0428
Practice Address - Fax:623-932-7847
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZOPT-002755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist