Provider Demographics
NPI:1558469825
Name:JERRY B. COTNER M.D., P.A.
Entity Type:Organization
Organization Name:JERRY B. COTNER M.D., P.A.
Other - Org Name:OPHTHALMOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:COTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-690-1922
Mailing Address - Street 1:770 N COIT RD
Mailing Address - Street 2:SUITE 2486
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 N COIT RD
Practice Address - Street 2:SUITE #2486
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5426
Practice Address - Country:US
Practice Address - Phone:972-630-1922
Practice Address - Fax:972-235-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00233TMedicare PIN