Provider Demographics
NPI:1669463972
Name:COBB, RAYMOND WAYNE JR (OD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WAYNE
Last Name:COBB
Suffix:JR
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-2087
Mailing Address - Country:US
Mailing Address - Phone:205-921-5499
Mailing Address - Fax:205-921-0691
Practice Address - Street 1:1520 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5006
Practice Address - Country:US
Practice Address - Phone:205-921-5499
Practice Address - Fax:205-921-0691
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS769TA002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058646OtherMEDICARE
AL000058646Medicaid
U52587Medicare UPIN
AL000058646OtherMEDICARE