Provider Demographics
NPI:1184693897
Name:COCHRANE, KELLY JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JAMES
Last Name:COCHRANE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4013
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-4013
Mailing Address - Country:US
Mailing Address - Phone:509-547-6998
Mailing Address - Fax:509-547-6966
Practice Address - Street 1:9825 SANDIFUR PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6738
Practice Address - Country:US
Practice Address - Phone:509-547-6998
Practice Address - Fax:509-547-6966
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1536TX152W00000X
OR1629D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410016585OtherUPPR
022886003OtherREGENCE OREGON
032340000OtherCIGNA
WA2009488Medicaid
CO6992OtherREGENCE WASHINGTON
554048OtherAETNA
610605300OtherDEPT OF LABOR SEATTLE DFE
8886644808OtherCOMM HEALTH PLAN OF WA
25764890OtherGROUP HEALTH
410016584OtherTRAVELERS MEDICARE RETIRE
0323400001OtherMC SUPPY CIGNA DMERC REGD
WA0226424OtherDEPT LABOR AND INDUSTRIES
0323400001OtherMC SUPPY CIGNA DMERC REGD
WA0226424OtherDEPT LABOR AND INDUSTRIES