Provider Demographics
NPI:1346219664
Name:COCKRELL, RALPH (OD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:COCKRELL
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 1:155 SE LOOP 338
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-9708
Mailing Address - Country:US
Mailing Address - Phone:432-367-7241
Mailing Address - Fax:432-550-3427
Practice Address - Street 1:155 SE LOOP 338
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-9703
Practice Address - Country:US
Practice Address - Phone:432-367-7241
Practice Address - Fax:432-550-3427
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2226T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133535808Medicaid
TX133535808Medicaid
TX81350EMedicare ID - Type Unspecified