Provider Demographics
NPI:1275725152
Name:COHRON FAMILY OPTOMETRIC SERVICES INC
Entity Type:Organization
Organization Name:COHRON FAMILY OPTOMETRIC SERVICES INC
Other - Org Name:TODD COHRON OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLCE
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:COHRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-526-6800
Mailing Address - Street 1:112 E MCMURTRY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1634
Mailing Address - Country:US
Mailing Address - Phone:270-298-7623
Mailing Address - Fax:270-298-7624
Practice Address - Street 1:112 E MCMURTRY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1634
Practice Address - Country:US
Practice Address - Phone:270-298-7623
Practice Address - Fax:270-298-7624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1372DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY410032987OtherRAILROAD MEDICARE IN HART
KY410032989OtherRAILROAD MEDICARE IN MORG
KY02144OtherSPECTERA IN HARTFORD
KY77013720Medicaid
KY000000041898OtherBLUE CROSS/BLUE SHIELD
KY1524171OtherUMWA
KY000000041897OtherBLUE CROSS IN MORGANTOWN
KY02145OtherSPECTERA MORGANTOWN
KY77013720Medicaid
KY1186600002Medicare NSC
KY9358302Medicare PIN
KY9358301Medicare PIN
KY02145OtherSPECTERA MORGANTOWN