Provider Demographics
NPI:1568510816
Name:DR JAMES W COBB, JR, PA
Entity Type:Organization
Organization Name:DR JAMES W COBB, JR, PA
Other - Org Name:BREVARD VISION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:COBB
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:321-724-2020
Mailing Address - Street 1:2186 HARRIS AVE NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4044
Mailing Address - Country:US
Mailing Address - Phone:321-724-2020
Mailing Address - Fax:321-724-9088
Practice Address - Street 1:2186 HARRIS AVE NE
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4044
Practice Address - Country:US
Practice Address - Phone:321-724-2020
Practice Address - Fax:321-724-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34850OtherBLUE CROSS BLUE SHIELD
FL620505400Medicaid
FL0480310001Medicare NSC
FLK0955Medicare PIN