Provider Demographics
NPI:1114917028
Name:COSGROVE, PAMELA LYNN (OD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:HELBRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:57 FAIRFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38558-4417
Mailing Address - Country:US
Mailing Address - Phone:931-484-3344
Mailing Address - Fax:931-456-3671
Practice Address - Street 1:57 FAIRFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38558-4417
Practice Address - Country:US
Practice Address - Phone:931-484-3344
Practice Address - Fax:931-456-3671
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC03074152W00000X
TN1477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ053998Medicaid
FL620283700Medicaid
FL20786ZMedicare PIN