Provider Demographics
NPI:1669558292
Name:COBB, WILLIAM WESLEY (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WESLEY
Last Name:COBB
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 1:128 COUNTRY RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1742
Mailing Address - Country:US
Mailing Address - Phone:256-701-4335
Mailing Address - Fax:
Practice Address - Street 1:128 COUNTRY RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-1742
Practice Address - Country:US
Practice Address - Phone:256-655-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-705 TA-394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL 0705OtherEYEMED VISION CARE
AL510-31731OtherBC&BS OF AL
AL510-31731OtherBC&BS OF AL
ALAL 0705OtherEYEMED VISION CARE
AL6256720001Medicare NSC