Provider Demographics
NPI:1275925349
Name:COWBURN AND KEPPICH LLC
Entity Type:Organization
Organization Name:COWBURN AND KEPPICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COWBURN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-568-2661
Mailing Address - Street 1:135 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-1101
Mailing Address - Country:US
Mailing Address - Phone:724-568-2661
Mailing Address - Fax:724-567-2340
Practice Address - Street 1:135 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690-1101
Practice Address - Country:US
Practice Address - Phone:724-568-2661
Practice Address - Fax:724-567-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty