Provider Demographics
NPI:1457784308
Name:COX, MISTY LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:LYNNE
Last Name:COX
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 1:10701 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1074
Mailing Address - Country:US
Mailing Address - Phone:623-876-2020
Mailing Address - Fax:623-977-1750
Practice Address - Street 1:10701 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1074
Practice Address - Country:US
Practice Address - Phone:623-876-2020
Practice Address - Fax:623-977-1750
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D09-TA-956152W00000X
TN3098152W00000X
AZ1980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ171900Medicare PIN