Provider Demographics
NPI:1528038296
Name:COSBY, JOHNNY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:LEE
Last Name:COSBY
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 1:3701 ESPEY HEDGEPETH RD
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MS
Mailing Address - Zip Code:39320-9705
Mailing Address - Country:US
Mailing Address - Phone:601-934-2231
Mailing Address - Fax:
Practice Address - Street 1:4721 26TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-4703
Practice Address - Country:US
Practice Address - Phone:601-485-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS992TA577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist