Provider Demographics
NPI:1669629812
Name:DR J BARRY COCHRAN PA
Entity Type:Organization
Organization Name:DR J BARRY COCHRAN PA
Other - Org Name:NORTHWOOD VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-725-5558
Mailing Address - Street 1:2518 N MCMULLEN BOOTH RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4156
Mailing Address - Country:US
Mailing Address - Phone:727-725-5558
Mailing Address - Fax:727-724-3966
Practice Address - Street 1:2518 N MCMULLEN BOOTH RD STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4156
Practice Address - Country:US
Practice Address - Phone:727-725-5558
Practice Address - Fax:727-724-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0906630001Medicare NSC