Coolbaugh, Kevin Thomas

Coolbaugh, Kevin Thomas is an individual health care provider with primary practice located at 1960 Electric Rd , Roanoke VA 24018-1621. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Coolbaugh, Kevin Thomas can be contacted via phone (540) 772-7171.

Contact Information

Primary practice address
1960 Electric Rd Roanoke VA 24018-1621
Phone: (540) 772-7171
Fax: (540) 774-8299
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 0601002107 Virginia

Profile Details

NPI number 1306842695
LBN Legal business name Coolbaugh, Kevin Thomas
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Feb 2nd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306842695 NPPES
Virginia MEDICAID 9232800

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