Provider Demographics
NPI:1851403877
Name:JOHN D. COBLE
Entity Type:Organization
Organization Name:JOHN D. COBLE
Other - Org Name:EYECARE OF GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-454-1886
Mailing Address - Street 1:4501 JOE RAMSEY BLVD E STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7838
Mailing Address - Country:US
Mailing Address - Phone:903-454-1886
Mailing Address - Fax:903-455-3055
Practice Address - Street 1:4501 JOE RAMSEY BLVD E STE 110
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7838
Practice Address - Country:US
Practice Address - Phone:903-454-1886
Practice Address - Fax:903-455-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
TX3622TG261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3093296-01Medicaid
TX3093296-01Medicaid