Provider Demographics
NPI:1043430317
Name:COBLER, DENNIS DWAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DWAYNE
Last Name:COBLER
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 1:456 CHERRY ST. SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-458-1187
Mailing Address - Fax:616-458-7113
Practice Address - Street 1:1045 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:N MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-2029
Practice Address - Country:US
Practice Address - Phone:231-744-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002250152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation