Provider Demographics
NPI:1679564736
Name:COHEN, HOWARD ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:ROBERT
Last Name:COHEN
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 1:190 CORAM AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3347
Mailing Address - Country:US
Mailing Address - Phone:203-924-2175
Mailing Address - Fax:203-924-9232
Practice Address - Street 1:190 CORAM AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3347
Practice Address - Country:US
Practice Address - Phone:203-924-2175
Practice Address - Fax:203-924-9232
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT18812OtherSPECTERA
CT000777OtherHEALTHNET
CT906160OtherHEALTHNET
004754OtherHEALTHY OPTIONS
CT1919OtherDAVIS VISION
CT0128710001OtherDMERC REGION A
CT090000738CT01OtherBLUE CROSS
CT117636OtherEYEMED
CT763317OtherCONNECTICARE
CTP404250OtherOXFORD
CT1919OtherDAVIS VISION