Provider Demographics
NPI:1164604070
Name:COHEN, JOSEPH S (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:COHEN
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 1:19737 VENTURA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2605
Mailing Address - Country:US
Mailing Address - Phone:818-345-3937
Mailing Address - Fax:818-346-3380
Practice Address - Street 1:19737 VENTURA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2605
Practice Address - Country:US
Practice Address - Phone:818-345-3937
Practice Address - Fax:818-346-3380
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4140470001Medicare NSC
CAOP9974Medicare PIN