Provider Demographics
NPI:1932193794
Name:COX, CONWAY STEWART (OD)
Entity Type:Individual
Prefix:DR
First Name:CONWAY
Middle Name:STEWART
Last Name:COX
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 1:106 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1006
Mailing Address - Country:US
Mailing Address - Phone:812-385-5520
Mailing Address - Fax:
Practice Address - Street 1:106 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1006
Practice Address - Country:US
Practice Address - Phone:812-385-5520
Practice Address - Fax:812-386-6556
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002847B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200112370Medicaid
INU64854Medicare UPIN
IN143260Medicare ID - Type Unspecified
IN5069770001Medicare NSC