Provider Demographics
NPI:1134114531
Name:KOCKS, C. STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:C.
Middle Name:STEVEN
Last Name:KOCKS
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 1:5319 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8617
Mailing Address - Country:US
Mailing Address - Phone:989-793-9383
Mailing Address - Fax:
Practice Address - Street 1:1885 N CENTER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5565
Practice Address - Country:US
Practice Address - Phone:989-792-8686
Practice Address - Fax:989-792-8382
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI490100 3083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI490100 3083OtherSTATE LICENSE NUMBER
MI01000819OtherHEALTH PLUS
MI4742203Medicaid
MI4742203Medicaid
MI490100 3083OtherSTATE LICENSE NUMBER