1275725152 NPI number — COHRON FAMILY OPTOMETRIC SERVICES INC

Table of content: (NPI 1275725152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275725152 NPI number — COHRON FAMILY OPTOMETRIC SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COHRON FAMILY OPTOMETRIC SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TODD COHRON OD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275725152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 E MCMURTRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42347-1634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-298-7623
Provider Business Mailing Address Fax Number:
270-298-7624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 E MCMURTRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42347-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-298-7623
Provider Business Practice Location Address Fax Number:
270-298-7624
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COHRON
Authorized Official First Name:
WALLCE
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
270-526-6800

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1372DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410032987 . This is a "RAILROAD MEDICARE IN HART" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 410032989 . This is a "RAILROAD MEDICARE IN MORG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 02144 . This is a "SPECTERA IN HARTFORD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77013720 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000041898 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1524171 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000041897 . This is a "BLUE CROSS IN MORGANTOWN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 02145 . This is a "SPECTERA MORGANTOWN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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