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NPI Code Detail

MEDICARE: KEVIN COTTER ODPA

MEDICARE: KEVIN COTTER ODPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristODP-935ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11592829OTHERIDMEDICARE PROVIDER NUMBER

General Provider Information

NPI Number : 1245420926
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEVIN COTTER ODPA
Provider Business Mailing Address
First Line : 618 WINTHER BLVD
Second Line :
City : NAMPA
State : ID
Zip : 83651-6542
Country : US
Telephone Number : 208-466-1395
Fax Number : 208-466-1395
Provider Business Practice Location Address
First Line : 5108 CLEVELAND BLVD
Second Line :
City : CALDWELL
State : ID
Zip : 83607-8002
Country : US
Telephone Number : 208-455-2197
Fax Number : 208-455-2198
Authorized Official
Title or Position : OWNER
Name : DR. KEVIN COTTER
Credential : OD
Telephone Number : 208-455-2197
Provider Enumeration Date : 07/27/2007
Last Update Date : 07/27/2007

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