Provider Demographics
NPI:1013932193
Name:COHEN, RICHARD J (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
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 1:514 E WOOLBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6033
Mailing Address - Country:US
Mailing Address - Phone:561-734-2972
Mailing Address - Fax:561-734-4780
Practice Address - Street 1:514 E WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6033
Practice Address - Country:US
Practice Address - Phone:561-734-2972
Practice Address - Fax:561-734-4780
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621135600Medicaid
FLE6044Medicare PIN
FL621135600Medicaid