Provider Demographics
NPI:1588661573
Name:COTTINGHAM, ROBERT L (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:COTTINGHAM
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 1:1997 BARRETT CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2667
Mailing Address - Country:US
Mailing Address - Phone:270-826-9966
Mailing Address - Fax:270-827-1206
Practice Address - Street 1:1997 BARRETT CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2667
Practice Address - Country:US
Practice Address - Phone:270-826-9966
Practice Address - Fax:270-827-1206
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYK1622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0937703Medicare ID - Type Unspecified
V01819Medicare UPIN