Provider Demographics
NPI:1558468132
Name:COHEN, HENRY (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:COHEN
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 1:1550 WORCESTER RD
Mailing Address - Street 2:225
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8968
Mailing Address - Country:US
Mailing Address - Phone:508-872-5460
Mailing Address - Fax:
Practice Address - Street 1:51 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7448
Practice Address - Country:US
Practice Address - Phone:617-566-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15200000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0344002Medicaid
T59078Medicare UPIN
MA141358Medicare ID - Type Unspecified