Provider Demographics
NPI:1679732127
Name:COHRON FAMILY OPTOMETRIC SERVICES INC
Entity Type:Organization
Organization Name:COHRON FAMILY OPTOMETRIC SERVICES INC
Other - Org Name:TODD COHRON OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:COHRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-526-6800
Mailing Address - Street 1:221 W G L SMITH ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-8602
Mailing Address - Country:US
Mailing Address - Phone:270-526-6800
Mailing Address - Fax:270-526-5462
Practice Address - Street 1:221 W G L SMITH ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-8602
Practice Address - Country:US
Practice Address - Phone:270-526-6800
Practice Address - Fax:270-526-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1372 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY410032989OtherRAILROAD MEDICARE
KYKY1372OtherEYEMED
KY1186600002OtherPALMETTO
KY47316OtherAVESIS
KY77902765Medicaid
KY000000041897OtherBLUE CROSS/BLUE SHIELD
KY02145OtherSPECTERA
KY35962OtherDAVIS VISION
KY47316OtherAVESIS
KY1186600002OtherPALMETTO