Provider Demographics
NPI:1295801983
Name:COCHRAN, DONALD BRUCE (OD OPTOMETRY DOCTOR)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BRUCE
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:OD OPTOMETRY DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 DREW STREET
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765
Mailing Address - Country:US
Mailing Address - Phone:813-446-8186
Mailing Address - Fax:813-446-8186
Practice Address - Street 1:1943 DREW STREET
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765
Practice Address - Country:US
Practice Address - Phone:727-446-8186
Practice Address - Fax:727-446-8186
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
853OtherFLORIDA LICENSE
P00045759OtherRR MEDICARE
FL1295801983OtherNPI
650106692OtherTAX ID
GAP00045759OtherMEDICARE RAILROAD
FL620631000Medicaid
GAP00045759OtherMEDICARE RAILROAD
650106692OtherTAX ID
19129Medicare ID - Type Unspecified
FL620631000Medicaid