Provider Demographics
NPI:1669577086
Name:D. BRADLEY COBB O.D., PLLC
Entity type:Organization
Organization Name:D. BRADLEY COBB O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-333-8989
Mailing Address - Street 1:4037 NOWATA RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-5118
Mailing Address - Country:US
Mailing Address - Phone:918-333-8989
Mailing Address - Fax:918-333-8991
Practice Address - Street 1:4037 NOWATA RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-5118
Practice Address - Country:US
Practice Address - Phone:918-333-8989
Practice Address - Fax:918-333-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200107460AMedicaid
OKDG0202OtherRAILROAD MEDICARE
OK=========001OtherBCBS
OK200107460AMedicaid
OK800522532Medicare PIN