Provider Demographics
NPI:1891875043
Name:COBB, AMY NAILLING (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:NAILLING
Last Name:COBB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-6814
Mailing Address - Country:US
Mailing Address - Phone:806-373-4977
Mailing Address - Fax:806-373-5003
Practice Address - Street 1:826 MARTIN RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-6814
Practice Address - Country:US
Practice Address - Phone:806-373-4977
Practice Address - Fax:806-373-5003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6719TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177161001Medicaid
TX612004Medicare ID - Type Unspecified
TX177161001Medicaid