Provider Demographics
NPI:1174507677
Name:COBLE, JOHN D (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:COBLE
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 1:1501 SUNSET HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3216
Mailing Address - Country:US
Mailing Address - Phone:972-772-3937
Mailing Address - Fax:
Practice Address - Street 1:4501 JOE RAMSEY BLVD E
Practice Address - Street 2:STE. 110
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7836
Practice Address - Country:US
Practice Address - Phone:903-454-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3622TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309329601Medicaid
TX112395204Medicaid
TX0326050001Medicare NSC
TXTXB140316Medicare PIN
TX309329601Medicaid