Provider Demographics
NPI:1518356914
Name:COHEN, DANA L (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:L
Last Name:COHEN
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OCEAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4227
Mailing Address - Country:US
Mailing Address - Phone:781-254-8222
Mailing Address - Fax:781-395-0311
Practice Address - Street 1:1 OCEAN VIEW DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4227
Practice Address - Country:US
Practice Address - Phone:781-254-8222
Practice Address - Fax:781-395-0311
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1750156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician