Provider Demographics
NPI:1922170463
Name:COHEN, NEVILLE STANLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:NEVILLE
Middle Name:STANLEY
Last Name:COHEN
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 1:613 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4402
Mailing Address - Country:US
Mailing Address - Phone:760-743-4616
Mailing Address - Fax:760-480-7393
Practice Address - Street 1:613 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4402
Practice Address - Country:US
Practice Address - Phone:760-743-4616
Practice Address - Fax:760-480-7393
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6419T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist