Provider Demographics
NPI:1972608974
Name:COX, SAMUEL E (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:E
Last Name:COX
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 1:154 E ELM CRES
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1047
Mailing Address - Country:US
Mailing Address - Phone:423-943-3079
Mailing Address - Fax:
Practice Address - Street 1:2306 KNOB CREEK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2366
Practice Address - Country:US
Practice Address - Phone:423-929-2020
Practice Address - Fax:423-929-3140
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPOP25152W00000X
NC1349152W00000X
IA105592152W00000X
NYTUV009264152W00000X
TNODT1296152W00000X
MN3663152W00000X
COOPT.0003453152W00000X
VT030.0133915152W00000X
VA0618002847152W00000X
WI21391-875152W00000X
TX10889T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909102Medicaid
NC1490POtherBCBS OF NC PROVIDER NUMBER
TN1506424Medicaid
TN4012901OtherBCBS PROVIDER NUMBER
TN4012901OtherBCBS PROVIDER NUMBER
TNU35837Medicare UPIN
TN1506424Medicaid
NC2473165Medicare PIN