Provider Demographics
NPI:1245307834
Name:COHEN, DEBRA O'DONNELL (OD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:O'DONNELL
Last Name:COHEN
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 1:300 COLONY PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7235
Mailing Address - Country:US
Mailing Address - Phone:508-830-3443
Mailing Address - Fax:508-830-0689
Practice Address - Street 1:300 COLONY PLACE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7235
Practice Address - Country:US
Practice Address - Phone:508-830-3443
Practice Address - Fax:508-830-3443
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0002295OtherGROUP P TAN
1053503912OtherGROUP NPI
1245307834OtherNPI
1053503912OtherGROUP NPI