Provider Demographics
NPI:1801939996
Name:DR DONALD B COBB OD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR DONALD B COBB OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-336-5046
Mailing Address - Street 1:505 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3943
Mailing Address - Country:US
Mailing Address - Phone:918-336-5046
Mailing Address - Fax:918-336-5819
Practice Address - Street 1:505 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3943
Practice Address - Country:US
Practice Address - Phone:918-336-5046
Practice Address - Fax:918-336-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764780Medicaid
OK900522540OtherMEDICARE GROUP NUMBER
OK0344710001Medicare PIN
OK900522540OtherMEDICARE GROUP NUMBER
OK249705205Medicare PIN