Provider Demographics
NPI:1891765921
Name:COHEN, STEPHEN MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MITCHELL
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10900 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5216
Mailing Address - Country:US
Mailing Address - Phone:480-513-3937
Mailing Address - Fax:480-367-6711
Practice Address - Street 1:10900 N SCOTTSDALE RD
Practice Address - Street 2:SUITE #301
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5216
Practice Address - Country:US
Practice Address - Phone:480-513-3937
Practice Address - Fax:480-367-6711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41504Medicare UPIN