Provider Demographics
NPI:1982956777
Name:STEPHEN M. COHEN OD, P.C.
Entity Type:Organization
Organization Name:STEPHEN M. COHEN OD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-513-3937
Mailing Address - Street 1:10900 N SCOTTSDALE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5230
Mailing Address - Country:US
Mailing Address - Phone:480-513-3937
Mailing Address - Fax:480-367-6711
Practice Address - Street 1:10900 N SCOTTSDALE RD STE 301
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5230
Practice Address - Country:US
Practice Address - Phone:480-513-3937
Practice Address - Fax:480-367-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ90890Medicare PIN