Provider Demographics
NPI:1669437901
Name:COSGROVE, DENNIS L (OD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:COSGROVE
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 1:720 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1059 NEAL ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0906
Practice Address - Country:US
Practice Address - Phone:931-528-1304
Practice Address - Fax:931-372-8958
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU43819Medicare UPIN
TN3945645Medicare PIN
TN3944210Medicare PIN