Provider Demographics
NPI:1053307702
Name:COBLE, MARK G (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:COBLE
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Gender:M
Credentials:OD
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Mailing Address - Street 1:9501 STATE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1871
Mailing Address - Country:US
Mailing Address - Phone:913-299-7200
Mailing Address - Fax:913-334-4451
Practice Address - Street 1:9501 STATE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-1872
Practice Address - Country:US
Practice Address - Phone:913-299-7200
Practice Address - Fax:913-334-4551
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2016-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1098-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS09088023OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KSN431976Medicare PIN
KS09088023OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KS410049606Medicare PIN