Provider Demographics
NPI:1649943408
Name:COBURN, JAMES ALEXANDER (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALEXANDER
Last Name:COBURN
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 1:742 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3866
Mailing Address - Country:US
Mailing Address - Phone:918-682-7752
Mailing Address - Fax:
Practice Address - Street 1:742 N YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3866
Practice Address - Country:US
Practice Address - Phone:918-682-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist