Provider Demographics
NPI:1689009177
Name:COBLE, JONATHAN ADAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ADAM
Last Name:COBLE
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 1:45 N DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3372
Mailing Address - Country:US
Mailing Address - Phone:931-526-2022
Mailing Address - Fax:931-528-1230
Practice Address - Street 1:45 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3372
Practice Address - Country:US
Practice Address - Phone:931-526-2022
Practice Address - Fax:931-528-1230
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist