Provider Demographics
NPI:1457436636
Name:COHEN, DAVID MARC (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARC
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 1:12409 MCALLISTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2495
Mailing Address - Country:US
Mailing Address - Phone:704-752-3727
Mailing Address - Fax:
Practice Address - Street 1:2301 DAVE LYLE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-6294
Practice Address - Country:US
Practice Address - Phone:803-329-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist