Provider Demographics
NPI:1255473096
Name:COTRELL, PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:COTRELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:
Other - Last Name:COTRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8537 PARK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2055
Mailing Address - Country:US
Mailing Address - Phone:440-479-8557
Mailing Address - Fax:330-468-0211
Practice Address - Street 1:8160 MACEDONIA COMMONS BLVD
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1843
Practice Address - Country:US
Practice Address - Phone:330-468-0404
Practice Address - Fax:330-468-0211
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4827 T1692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist