Provider Demographics
NPI:1871606681
Name:COULTER, ERIC W (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:COULTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 8TH AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3662
Mailing Address - Country:US
Mailing Address - Phone:907-569-1551
Mailing Address - Fax:907-569-1564
Practice Address - Street 1:235 E 8TH AVE STE 3A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3662
Practice Address - Country:US
Practice Address - Phone:907-569-1551
Practice Address - Fax:907-569-1564
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4540207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2963Medicaid
AKG70000Medicare UPIN
AK152050Medicare ID - Type Unspecified