Provider Demographics
NPI:1841244878
Name:COHAN, TODD G (OD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:G
Last Name:COHAN
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 1:4160 IL ROUTE 83
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8034
Mailing Address - Country:US
Mailing Address - Phone:847-955-9393
Mailing Address - Fax:847-955-9857
Practice Address - Street 1:4160 IL RTE 83
Practice Address - Street 2:SUITE 107
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-955-9393
Practice Address - Fax:847-955-9857
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001604768OtherBLUE CROSS BLUE SHIELD
P00005501OtherRAILROAD MEDICARE
IL046009356Medicaid
ILU86422Medicare UPIN
L99904Medicare PIN
P00005501OtherRAILROAD MEDICARE
IL046009356Medicaid
L87459Medicare PIN
0839990001Medicare NSC