Provider Demographics
NPI:1811977937
Name:COHRON, WALLACE TODD (OD)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:TODD
Last Name:COHRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:221 W GL SMITH ST
Mailing Address - Street 2:PO BOX 1007
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-1007
Mailing Address - Country:US
Mailing Address - Phone:270-526-6800
Mailing Address - Fax:270-526-5462
Practice Address - Street 1:221 W GL SMITH ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-1007
Practice Address - Country:US
Practice Address - Phone:270-526-6800
Practice Address - Fax:270-526-5462
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1372DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000041898OtherBLUE CROSS/BLU SHIELD
KY1524171OtherUMWA FUNDS
KY410032987OtherRAILROAD MEDICARE IN HART
KY410032989OtherRAILROAD MEDICARE IN MORG
KY000000041897OtherBLUE CROSS
KY02144OtherSPECTERA IN HARTFORD
KY02145OtherSPECTERA IN MORGANTOWN
KY77013720Medicaid
KY000000041897OtherBLUE CROSS
KY02144OtherSPECTERA IN HARTFORD
KY9358302Medicare ID - Type UnspecifiedMORGANTOWN
KY77013720Medicaid
KY1186600001Medicare NSC